Provider Demographics
NPI:1821165259
Name:FALSETTI, LAURA SUSAN (DMD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SUSAN
Last Name:FALSETTI
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 1:1778 MCLEOD CIR
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-9793
Mailing Address - Country:US
Mailing Address - Phone:814-571-1126
Mailing Address - Fax:
Practice Address - Street 1:US ARMY DENTAL ACTIVITY FORT LEWIS
Practice Address - Street 2:BLDG 9900, LINCOLN STREET
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:814-571-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027584L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist