Provider Demographics
NPI:1114092764
Name:CARDENAS, LAURA (DDS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-4528
Mailing Address - Country:US
Mailing Address - Phone:253-485-7500
Mailing Address - Fax:253-475-9115
Practice Address - Street 1:4545 S UNION AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-4528
Practice Address - Country:US
Practice Address - Phone:253-485-7500
Practice Address - Fax:253-475-9115
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000096151223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics