Provider Demographics
NPI:1316202815
Name:HERSCHDORFER, LAURA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:HERSCHDORFER
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 1:2500 BISCAYNE BLVD APT 604
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4565
Mailing Address - Country:US
Mailing Address - Phone:860-983-4515
Mailing Address - Fax:
Practice Address - Street 1:2999 NE 191ST ST STE 804
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3387
Practice Address - Country:US
Practice Address - Phone:305-466-1804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN22621122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty