Provider Demographics
NPI:1972573004
Name:MEDRANO-SALDANA, LAURO F (DDS)
Entity Type:Individual
Prefix:
First Name:LAURO
Middle Name:F
Last Name:MEDRANO-SALDANA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3806
Mailing Address - Country:US
Mailing Address - Phone:718-492-3677
Mailing Address - Fax:718-492-3637
Practice Address - Street 1:5802 6TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3806
Practice Address - Country:US
Practice Address - Phone:718-492-3677
Practice Address - Fax:718-492-3637
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046955122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01732778Medicaid