Provider Demographics
NPI:1043704661
Name:ALSOBROOKS, LAURA MARIE (RDH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:MARIE
Last Name:ALSOBROOKS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3185 W HOUGHTON LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HOUGHTON LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48629-8242
Mailing Address - Country:US
Mailing Address - Phone:989-366-9621
Mailing Address - Fax:989-366-8237
Practice Address - Street 1:3185 W HOUGHTON LAKE DR
Practice Address - Street 2:
Practice Address - City:HOUGHTON LAKE
Practice Address - State:MI
Practice Address - Zip Code:48629-8242
Practice Address - Country:US
Practice Address - Phone:989-366-9621
Practice Address - Fax:989-366-8237
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902007113124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist