Provider Demographics
NPI:1235571860
Name:GORDON, LAURA SCHMADEKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:SCHMADEKE
Last Name:GORDON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:NICOLE
Other - Last Name:SCHMADEKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14202 Y ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2862
Mailing Address - Country:US
Mailing Address - Phone:402-895-2085
Mailing Address - Fax:
Practice Address - Street 1:14202 Y ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2807
Practice Address - Country:US
Practice Address - Phone:402-895-2085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2019-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7076122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist