Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | RDH2613 |
NPI | 1043794993 |
---|---|
Provider Name | Jolene Pierce |
First Address | Hampden, ME 04444-3210 |
Second Address | Bangor, ME 04401-5087 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2018 |
Last Update Date | 17/09/2018 |