Provider Demographics
NPI:1073841482
Name:LAURITZEN, TROY ARTHUR (DDS)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:ARTHUR
Last Name:LAURITZEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 MORAGA RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4507
Mailing Address - Country:US
Mailing Address - Phone:925-283-0114
Mailing Address - Fax:925-283-3296
Practice Address - Street 1:907 MORAGA RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4507
Practice Address - Country:US
Practice Address - Phone:925-283-0114
Practice Address - Fax:925-283-3296
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA438071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice