Provider Demographics
NPI:1578594859
Name:PASSERI, LAURI ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURI
Middle Name:ANN
Last Name:PASSERI
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 1:36 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WIND GAP
Mailing Address - State:PA
Mailing Address - Zip Code:18091-1501
Mailing Address - Country:US
Mailing Address - Phone:610-863-6062
Mailing Address - Fax:610-863-9906
Practice Address - Street 1:36 W 1ST ST
Practice Address - Street 2:
Practice Address - City:WIND GAP
Practice Address - State:PA
Practice Address - Zip Code:18091-1501
Practice Address - Country:US
Practice Address - Phone:610-863-6062
Practice Address - Fax:610-863-9906
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028321L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist