Basic Information
| Provider Information | |||||||||
| NPI: | 1578630778 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHOUINARD | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | |||||||||
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| Credential: | RDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 569 | ||||||||
| Address2: | 42 DALLAS HILL RD | ||||||||
| City: | RANGELEY | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049700569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078643303 | ||||||||
| FaxNumber: | 2078642969 | ||||||||
| Practice Location | |||||||||
| Address1: | 177 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | STRONG | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049833005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076843045 | ||||||||
| FaxNumber: | 2076843049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 2723 | ME | Y | Dental Providers | Dental Hygienist |
ID Information
| ID | Type | State | Issuer | Description | 2723 | 01 | ME | HYGIENIST LICENSE | OTHER |