Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2914 | ME |
NPI | 1043382658 |
---|---|
Provider Name | Ms. Mary C Repole |
First Address | Eastport, ME 04631 |
Second Address | Princeton, ME 04668 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/07/2007 |