Provider Demographics
NPI:1083675813
Name:ENG, LAURA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:ENG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MAIN ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1080
Mailing Address - Country:US
Mailing Address - Phone:651-227-6561
Mailing Address - Fax:651-297-6852
Practice Address - Street 1:411 MAIN ST
Practice Address - Street 2:SUITE 308
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1080
Practice Address - Country:US
Practice Address - Phone:651-227-6561
Practice Address - Fax:651-297-6852
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9068122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist