=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386239960
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN HOLLAND RDH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2021
-----------------------------------------------------
Last Update Date | 03/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3349 THRASHER RD
-----------------------------------------------------
City | HIAWATHA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-595-3450
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6407 NE 156TH ST
-----------------------------------------------------
City | SMITHVILLE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64089-8195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-689-8903
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 12955
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------