Healthcare Provider Details

I. General information

NPI: 1265901581
Provider Name (Legal Business Name): LEASHA LYNN SMITH RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEASHA LYNN SMITH-LYNCH RDH

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 03/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3327 W CAPITAL AVE
GRAND ISLAND NE
68803-1334
US

IV. Provider business mailing address

1003 W 3RD ST
GRAND ISLAND NE
68801-5831
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-4297
  • Fax:
Mailing address:
  • Phone: 308-382-0110
  • Fax: 308-382-8504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number2871
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: