Provider Demographics
NPI:1730257254
Name:KASPRAK, CATHERINE J (RDH, IPDH)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:J
Last Name:KASPRAK
Suffix:
Gender:F
Credentials:RDH, IPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171-B PORTLAND ROAD
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009-4210
Mailing Address - Country:US
Mailing Address - Phone:207-647-4125
Mailing Address - Fax:207-647-4126
Practice Address - Street 1:171-B PORTLAND ROAD
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-4210
Practice Address - Country:US
Practice Address - Phone:207-647-4125
Practice Address - Fax:207-647-4126
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2239124Q00000X
ME2927H124Q00000X
MA10976124Q00000X
MEIPDH8124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431574399Medicaid
NH30533104Medicaid