Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | RDH4227 | ME |
NPI | 1023665239 |
---|---|
Provider Name | Lily A Young |
First Address | Patten, ME 04765-3007 |
Second Address | Millinocket, ME 04462-1400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2019 |
Last Update Date | 09/09/2020 |