Provider Demographics
NPI:1003036914
Name:LAURA LAITA,DDS & KEITH E PETRANEK,DDS
Entity Type:Organization
Organization Name:LAURA LAITA,DDS & KEITH E PETRANEK,DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:PETRANEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-344-3434
Mailing Address - Street 1:937 S MANNHEIM RD
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-2552
Mailing Address - Country:US
Mailing Address - Phone:708-344-3434
Mailing Address - Fax:
Practice Address - Street 1:937 S MANNHEIM RD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-2552
Practice Address - Country:US
Practice Address - Phone:708-344-3434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty