Provider Demographics
NPI:1225251846
Name:GAN, LAURIE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:A
Last Name:GAN
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 1:345 S COAST HIGHWAY 101
Mailing Address - Street 2:SUITE E
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3551
Mailing Address - Country:US
Mailing Address - Phone:760-632-0320
Mailing Address - Fax:760-632-0380
Practice Address - Street 1:345 S COAST HIGHWAY 101
Practice Address - Street 2:SUITE E
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3551
Practice Address - Country:US
Practice Address - Phone:760-632-0320
Practice Address - Fax:760-632-0380
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist