Individual
LAURA MARIE PROVANCHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
188 SUMMER ST, DOVER FOXCROFT, ME 04426-1129
(207) 538-3700
Mailing address
2741 HARRISON AVE, EUREKA, CA 95501-4737
(843) 592-7987
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
10586
SC
Other
Enumeration date
10/10/2024
Last updated
10/10/2024
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