Provider Demographics
NPI:1609373497
Name:MCNAMARA, CHRISTINE ALICE
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ALICE
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 VERANDA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-5328
Mailing Address - Country:US
Mailing Address - Phone:207-317-1852
Mailing Address - Fax:
Practice Address - Street 1:300 TECHNOLOGY WAY
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7654
Practice Address - Country:US
Practice Address - Phone:207-883-4203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH3721124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist