Provider Demographics
NPI:1255663555
Name:HERNANDEZ-DAUER, LAURA S (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:S
Last Name:HERNANDEZ-DAUER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:S
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:130 EAST RESERVOIR ROAD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664
Mailing Address - Country:US
Mailing Address - Phone:540-459-2173
Mailing Address - Fax:540-459-4274
Practice Address - Street 1:130 EAST RESERVOIR ROAD
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664
Practice Address - Country:US
Practice Address - Phone:540-459-2173
Practice Address - Fax:540-459-4274
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014127141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9225414Medicaid