Provider Demographics
NPI:1548773377
Name:LAMPHERE, ABRIELLE KAY (RDH)
Entity Type:Individual
Prefix:
First Name:ABRIELLE
Middle Name:KAY
Last Name:LAMPHERE
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:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:MI
Mailing Address - Zip Code:49327-0007
Mailing Address - Country:US
Mailing Address - Phone:231-834-9750
Mailing Address - Fax:231-834-1459
Practice Address - Street 1:11 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:MI
Practice Address - Zip Code:49327-7900
Practice Address - Country:US
Practice Address - Phone:231-834-9750
Practice Address - Fax:231-834-1459
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7751124Q00000X
VA0402207264124Q00000X
MI2902018396124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2902018396OtherBOARD OF DENTISTRY