Provider Demographics
NPI:1366164386
Name:MAINE MOBILE DENTAL HYGIENE LLC
Entity type:Organization
Organization Name:MAINE MOBILE DENTAL HYGIENE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:SLAVING
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:207-233-7639
Mailing Address - Street 1:30 CAPTAINS WAY UNIT 301
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-5122
Mailing Address - Country:US
Mailing Address - Phone:207-233-7639
Mailing Address - Fax:
Practice Address - Street 1:30 CAPTAINS WAY UNIT 301
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-5122
Practice Address - Country:US
Practice Address - Phone:207-233-7639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty