Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | IPH98 | ME |
NPI | 1003851031 |
---|---|
Provider Name | Nancy Boyd Bears |
First Address | Patten, ME 04765-0500 |
Second Address | Millinocket, ME 04462-1400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 02/09/2016 |