Provider Demographics
NPI:1750460309
Name:GREENWALD, LAURA DAWN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:DAWN
Last Name:GREENWALD
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 1:25757 LETICIA DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-2263
Mailing Address - Country:US
Mailing Address - Phone:661-993-3889
Mailing Address - Fax:
Practice Address - Street 1:25757 LETICIA DR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2263
Practice Address - Country:US
Practice Address - Phone:661-993-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051853-11223P0221X
CA565541223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18789358Medicaid
AZ951865Medicaid