=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285045583
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN NICOLE VAN GEMERT D.D.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2014
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1118 S PERRY ST
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99202-3525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-688-0688
-----------------------------------------------------
Fax | 509-340-8939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1118 S PERRY ST
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99202-3525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-688-0688
-----------------------------------------------------
Fax | 509-340-8939
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DE60615115
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------