Provider Demographics
NPI:1437776218
Name:DAZA, LAURA C (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:C
Last Name:DAZA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 WINTER ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3139
Mailing Address - Country:US
Mailing Address - Phone:603-332-7300
Mailing Address - Fax:
Practice Address - Street 1:40 WINTER ST STE 201
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-3139
Practice Address - Country:US
Practice Address - Phone:603-332-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH045711223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice