Healthcare Provider Details

I. General information

NPI: 1457800559
Provider Name (Legal Business Name): LAUREN HAPEMAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2016
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 LOCUST ST
PHILADELPHIA PA
19107-5453
US

IV. Provider business mailing address

2715 W GIRARD AVE
PHILADELPHIA PA
19130-1212
US

V. Phone/Fax

Practice location:
  • Phone: 303-502-6209
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH072263
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: