Individual
LOREENE A STACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1600 FOREST AVE, PORTLAND, ME 04103-1314
(207) 541-6631
Mailing address
389 CONGRESS ST, ROOM 307, PORTLAND, ME 04101-3566
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
RDH3132
ME
Other
Enumeration date
04/02/2014
Last updated
04/02/2014
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