Provider Demographics
NPI:1114066123
Name:BOLAND, SANDRA LIN (RDH)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LIN
Last Name:BOLAND
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 1:269 TOWN FARM RD
Mailing Address - Street 2:
Mailing Address - City:NEW GLOUCESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04260-4438
Mailing Address - Country:US
Mailing Address - Phone:207-926-3493
Mailing Address - Fax:
Practice Address - Street 1:389 CONGRESS ST.
Practice Address - Street 2:HEALTH AND HUMAN SERVICES, CHILDREN'S ORAL HEALTH
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101
Practice Address - Country:US
Practice Address - Phone:207-541-6632
Practice Address - Fax:207-541-6891
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3157124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist