Individual
ASHLEY DAWN SOUCY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LD
Contact information
Practice address
980 FOREST AVE STE 104, PORTLAND, ME 04103-3357
(207) 774-7645
Mailing address
57 NOWELL ST, NORTH BERWICK, ME 03906-6519
(207) 794-5322
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DTR5539
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DTR5539
STATE OF MAINE DENTAL BOARD
ME
Enumeration date
08/03/2021
Last updated
08/03/2021
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