=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154768422
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATI LEE LAPLANTE EFDA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2013
-----------------------------------------------------
Last Update Date | 09/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9900 SE LINWOOD AVENUE
-----------------------------------------------------
City | MILWAUKIE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-984-8732
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9900 SE LINWOOD AVENUE
-----------------------------------------------------
City | MILWAUKIE
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-984-8732
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 126800000X
-----------------------------------------------------
Taxonomy Name | Dental Assistant
-----------------------------------------------------
License Number | 119372
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------