Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 5509 | ME |
NPI | 1053546663 |
---|---|
Provider Name | Rebecca J Connor |
First Address | Bangor, ME 04401 |
Second Address | Bangor, ME 04401-5932 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2009 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
433053499 | (05) | ME |