Lisa Boulet
Individual provider Active NPI Dental Hygienist · Winthrop, ME
NPI 1497087340 · NPPES record last updated Feb 3, 2010
Key facts
- NPI
- 1497087340
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- 2216 (ME)
- Practice address
- 676 Old Lewiston Rd
Winthrop, ME 04364 - Phone
- (207) 377-7003
- NPI assigned
- Feb 3, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2216 | ME | MD | Dental Hygienist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 2216 | ME | Yes |
Addresses
Primary practice location
676 Old Lewiston Rd
Winthrop, ME 04364
Mailing address
32 Fawn LN
Greene, ME 04236
Phone (207) 946-7728
NPI Registry JSON
{
"created_epoch": "1265155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265155200000",
"number": "1497087340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "32 FAWN LN",
"city": "GREENE",
"state": "ME",
"postal_code": "04236",
"telephone_number": "207-946-7728"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "676 OLD LEWISTON RD",
"city": "WINTHROP",
"state": "ME",
"postal_code": "04364",
"telephone_number": "207-377-7003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULET",
"first_name": "LISA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-02-03",
"last_updated": "2010-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "ME",
"license": "2216",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winthrop, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 3, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.