Provider Demographics
NPI:1396621454
Name:MCKINNON, JANELLE (RDH)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:MCKINNON
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 1:11 MIDDLE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5229
Mailing Address - Country:US
Mailing Address - Phone:207-560-9200
Mailing Address - Fax:
Practice Address - Street 1:11 MIDDLE ST APT 1
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5229
Practice Address - Country:US
Practice Address - Phone:207-560-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH3831124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist