Provider Demographics
NPI:1083065635
Name:SHIM, LAURA (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:SHIM
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8991 OREANA PEAK CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1386
Mailing Address - Country:US
Mailing Address - Phone:541-206-2072
Mailing Address - Fax:
Practice Address - Street 1:7855 BLUE DIAMOND RD STE 107
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-9354
Practice Address - Country:US
Practice Address - Phone:702-941-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS3-3781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics