Provider Demographics
NPI:1851750814
Name:REIN, LAURA ELISABETH (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ELISABETH
Last Name:REIN
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8419 CLIFFRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2119
Mailing Address - Country:US
Mailing Address - Phone:858-945-7175
Mailing Address - Fax:
Practice Address - Street 1:306 WALNUT AVE
Practice Address - Street 2:SUITE #33
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4978
Practice Address - Country:US
Practice Address - Phone:619-299-3560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA634111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics