Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 13114804022 | KS |
NPI | 1467797142 |
---|---|
Provider Name | Laura Hageman |
First Address | Smith Center, KS 66967-2605 |
Second Address | Smith Center, KS 66967-2605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2012 |
Last Update Date | 11/06/2015 |