Provider Demographics
NPI:1386871507
Name:SKILLING, CHERYL LYNNE (REGISTERED DENTAL HY)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:LYNNE
Last Name:SKILLING
Suffix:
Gender:F
Credentials:REGISTERED DENTAL HY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 NORTH RAYMOND RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04274
Mailing Address - Country:US
Mailing Address - Phone:207-737-2099
Mailing Address - Fax:
Practice Address - Street 1:24 GARDINER ST.
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:ME
Practice Address - Zip Code:04357
Practice Address - Country:US
Practice Address - Phone:207-737-2099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2160124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433839000OtherMAINECARE