Provider Demographics
NPI:1952183220
Name:MCALLISTER, LAUREN BROOKE (RDH, PHA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:BROOKE
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:RDH, PHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50512 COUNTY ROAD 20
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:NE
Mailing Address - Zip Code:69357-3516
Mailing Address - Country:US
Mailing Address - Phone:308-765-0099
Mailing Address - Fax:
Practice Address - Street 1:975 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-1712
Practice Address - Country:US
Practice Address - Phone:308-632-2540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2951124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist