Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | RDH4267 | ME |
NPI | 1053939025 |
---|---|
Provider Name | Ms. Raghda A. Salman |
First Address | Portland, ME 04102-1053 |
Second Address | Portland, ME 04102-1059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2020 |
Last Update Date | 07/07/2020 |