Provider Demographics
NPI:1265901581
Name:SMITH, LEASHA LYNN (RDH)
Entity type:Individual
Prefix:MS
First Name:LEASHA
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:LEASHA
Other - Middle Name:LYNN
Other - Last Name:SMITH-LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1003 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-5831
Mailing Address - Country:US
Mailing Address - Phone:308-382-0110
Mailing Address - Fax:308-382-8504
Practice Address - Street 1:3327 W CAPITAL AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1334
Practice Address - Country:US
Practice Address - Phone:308-382-4297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2871124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist