=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801050745
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LONA LYNN PRICE RDH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2008
-----------------------------------------------------
Last Update Date | 07/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 902 W MAIN ST
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37814-4515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-586-3432
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1656 SPRUCE DR
-----------------------------------------------------
City | SEVIERVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37876-7241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-428-0372
-----------------------------------------------------
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 | 6551
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------