Basic Information
| Provider Information | |||||||||
| NPI: | 1700851714 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH-BOUCHARD | ||||||||
| FirstName: | SHARON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RDH | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | |||||||||
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| OtherMiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 117 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | STRONG | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076843045 | ||||||||
| FaxNumber: | 2076843049 | ||||||||
| Practice Location | |||||||||
| Address1: | 117 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | STRONG | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076843045 | ||||||||
| FaxNumber: | 2076843049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | X | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 2274 | ME | Y | Dental Providers | Dental Hygienist |
No ID Information.