Provider Demographics
NPI:1871254383
Name:LAURA M AVERSANO, DDS, PLLC
Entity Type:Organization
Organization Name:LAURA M AVERSANO, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:M
Authorized Official - Last Name:AVERSANO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-910-2873
Mailing Address - Street 1:968 SUMMER SPRING VW
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-8646
Mailing Address - Country:US
Mailing Address - Phone:847-910-2873
Mailing Address - Fax:
Practice Address - Street 1:941 S HAVANA ST
Practice Address - Street 2:200
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3042
Practice Address - Country:US
Practice Address - Phone:303-341-5313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental