Provider Demographics
NPI:1033529482
Name:MACKEY, LAURA CLEMENTE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:CLEMENTE
Last Name:MACKEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 DOWLIN FORGE RD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1550
Mailing Address - Country:US
Mailing Address - Phone:610-363-0307
Mailing Address - Fax:610-363-7307
Practice Address - Street 1:165 DOWLIN FORGE RD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1550
Practice Address - Country:US
Practice Address - Phone:610-363-0307
Practice Address - Fax:610-363-7307
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA241651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice