Provider Demographics
NPI:1215264981
Name:KANE, CHANDRA W (RDH)
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:W
Last Name:KANE
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:PO BOX 1386
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04441-1386
Mailing Address - Country:US
Mailing Address - Phone:207-997-2936
Mailing Address - Fax:
Practice Address - Street 1:2 MATHEWS ROAD
Practice Address - Street 2:
Practice Address - City:MONSON
Practice Address - State:ME
Practice Address - Zip Code:04464-0000
Practice Address - Country:US
Practice Address - Phone:207-997-2936
Practice Address - Fax:207-997-2936
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2433124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434557000OtherMAINECARE BILLING PROVIDER NUMBER