Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2312 | NE |
NPI | 1033681689 |
---|---|
Provider Name | Kara Lilienthal |
First Address | Omaha, NE 68135-4272 |
Second Address | Omaha, NE 68135-4272 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2018 |
Last Update Date | 30/12/2019 |