Healthcare Provider Details

I. General information

NPI: 1548773377
Provider Name (Legal Business Name): ABRIELLE KAY LAMPHERE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 11/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 N MAPLE ST
GRANT MI
49327-7900
US

IV. Provider business mailing address

PO BOX 7
GRANT MI
49327-0007
US

V. Phone/Fax

Practice location:
  • Phone: 231-834-9750
  • Fax: 231-834-1459
Mailing address:
  • Phone: 231-834-9750
  • Fax: 231-834-1459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number7751
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number0402207264
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2902018396
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: