Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2902007113 | MI |
NPI | 1043704661 |
---|---|
Provider Name | Laura Marie Alsobrooks |
First Address | Houghton Lake, MI 48629-8242 |
Second Address | Houghton Lake, MI 48629-8242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2018 |
Last Update Date | 18/06/2018 |