Provider Demographics
NPI:1659421519
Name:KADLEC, LAURA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:L
Last Name:KADLEC
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 1:12043 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-2740
Mailing Address - Country:US
Mailing Address - Phone:818-761-8274
Mailing Address - Fax:818-761-0589
Practice Address - Street 1:12043 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-2740
Practice Address - Country:US
Practice Address - Phone:818-761-8274
Practice Address - Fax:818-761-0589
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA306021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice