Provider Demographics
NPI:1194546622
Name:GIFFIN, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GIFFIN
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 1:113 MAIN RD. SUITE 4
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04429
Mailing Address - Country:US
Mailing Address - Phone:207-843-3545
Mailing Address - Fax:
Practice Address - Street 1:113 MAIN RD. SUITE 4
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:ME
Practice Address - Zip Code:04429
Practice Address - Country:US
Practice Address - Phone:207-843-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH4327124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist