Provider Demographics
NPI:1164643573
Name:DODD, LAURA BROWNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:BROWNE
Last Name:DODD
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 1:17748 KENNISON LN
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-0821
Mailing Address - Country:US
Mailing Address - Phone:209-333-7555
Mailing Address - Fax:
Practice Address - Street 1:425 PINE ST
Practice Address - Street 2:
Practice Address - City:GALT
Practice Address - State:CA
Practice Address - Zip Code:95632-2055
Practice Address - Country:US
Practice Address - Phone:209-745-4607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40932122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist