Provider Demographics
NPI:1053767137
Name:LAURA KIRKLAND
Entity type:Organization
Organization Name:LAURA KIRKLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST ALTERNATIVE PRACTI
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:310-733-7735
Mailing Address - Street 1:PO BOX 1212
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272
Mailing Address - Country:US
Mailing Address - Phone:310-733-7735
Mailing Address - Fax:
Practice Address - Street 1:984 MONUMENT DRIVE
Practice Address - Street 2:207
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272
Practice Address - Country:US
Practice Address - Phone:310-733-7735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No125J00000XDental ProvidersDental TherapistGroup - Single Specialty
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed ChildrenGroup - Single Specialty