Provider Demographics
NPI:1043382658
Name:REPOLE, MARY C (RDH)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:REPOLE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 DEEP COVE RD.
Mailing Address - Street 2:
Mailing Address - City:EASTPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04631
Mailing Address - Country:US
Mailing Address - Phone:207-853-2661
Mailing Address - Fax:
Practice Address - Street 1:401 PETER DANA POINT RD.
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:ME
Practice Address - Zip Code:04668
Practice Address - Country:US
Practice Address - Phone:207-796-2321
Practice Address - Fax:207-796-2422
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2914124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist