MEDICARE: MS. LEASHA LYNN SMITH RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	2871	NE

General Provider Information

NPI Number	:	1265901581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEASHA LYNN SMITH RDH

Provider Business Mailing Address
First Line	:	1003 W 3RD ST
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68801-5831
Country	:	US
Telephone Number	:	308-382-0110
Fax Number	:	308-382-8504

Provider Business Practice Location Address
First Line	:	3327 W CAPITAL AVE
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-1334
Country	:	US
Telephone Number	:	308-382-4297
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2018
Last Update Date	:	03/18/2019

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