| NPI | 1205103728 |
|---|---|
| Former Name | LAUREN NIKOLE RUSH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901020492) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MI 2901020492) |
| Enumeration Date | 2011-11-29 |
| Last Update Date | 2019-01-16 |