Doctor Name: | LAUREN BOLLENBACK |
NPI Number: | 1275850687 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | DMD |
License Number: | 9380 |
Business Practice Address: | 9217 Us Highway 42 Prospect, KY - 400598858 |
Business Phone Number: | 5022284009 |
Business Fax Number: | |
Mailing Address: | 143 Evergreen Road, Suite 200 LOUISVILLE |
State: | KY |
Postal Code: | 402430000 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/24/2010 |
NPI Last Update Date: | 03/03/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | 9380 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NC |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |