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General NPI Number Information
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NPI Number | 1053767137
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Entity Type | Organization
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Legal Business Name | LAURA KIRKLAND
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Dates
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Enumeration Date | 05/09/2016
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Last Update Date | 05/09/2016
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Provider Practice Location Address
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Address Line | 984 MONUMENT DRIVE 207
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272
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Country | US
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Telephone | 310-733-7735
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1212
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City | PACIFIC PALISADES
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State | CA
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Zip | 90272
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Country | US
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Telephone | 310-733-7735
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Fax |
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Authorized Official
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Title or Position | DENTAL HYGIENIST ALTERNATIVE PRACTI
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Name | MS. LAURA KIRKLAND
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Credential | RDHAP
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Telephone | 310-733-7735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 125J00000X
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Taxonomy Name | Dental Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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