=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548631799
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. HANNAH R. DOLSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2015
-----------------------------------------------------
Last Update Date | 10/14/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 215 LINCOLN DR
-----------------------------------------------------
City | GREAT FALLS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59405-6787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-612-6143
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 LINCOLN DR
-----------------------------------------------------
City | GREAT FALLS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59405-6787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-612-6143
-----------------------------------------------------
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 | 2626
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------