Provider Demographics
NPI:1508006354
Name:MINAHAN, LARA D (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:LARA
Middle Name:D
Last Name:MINAHAN
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Gender:F
Credentials:DDS, MS
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Mailing Address - Street 1:18200 GEORGIA AVENUE
Mailing Address - Street 2:SUITE N
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832
Mailing Address - Country:US
Mailing Address - Phone:301-260-2030
Mailing Address - Fax:301-260-0633
Practice Address - Street 1:3423 OLNEY - LAYTONSVILLE RD.
Practice Address - Street 2:SUITE 3A
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832
Practice Address - Country:US
Practice Address - Phone:301-260-2030
Practice Address - Fax:301-260-0633
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2013-01-28
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Provider Licenses
StateLicense IDTaxonomies
MD127431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics