Provider Demographics
NPI:1720444227
Name:DAUPHINEE, DENIS RUSSELL (CSFA, LSA)
Entity type:Individual
Prefix:MR
First Name:DENIS
Middle Name:RUSSELL
Last Name:DAUPHINEE
Suffix:
Gender:M
Credentials:CSFA, LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:ME
Mailing Address - Zip Code:04411-5006
Mailing Address - Country:US
Mailing Address - Phone:207-817-3186
Mailing Address - Fax:
Practice Address - Street 1:24 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRADLEY
Practice Address - State:ME
Practice Address - Zip Code:04411-5006
Practice Address - Country:US
Practice Address - Phone:207-817-3186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-13
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME149949246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant