Provider Demographics
NPI:1972667111
Name:LAUB, MARGARIDA R (DMD)
Entity Type:Individual
Prefix:
First Name:MARGARIDA
Middle Name:R
Last Name:LAUB
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 1:205 WEST FIRST AVENUE
Mailing Address - Street 2:
Mailing Address - City:CAOL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61240
Mailing Address - Country:US
Mailing Address - Phone:309-799-3000
Mailing Address - Fax:309-799-3002
Practice Address - Street 1:205 WEST FIRST AVENUE
Practice Address - Street 2:
Practice Address - City:CAOL VALLEY
Practice Address - State:IL
Practice Address - Zip Code:61240
Practice Address - Country:US
Practice Address - Phone:309-799-3000
Practice Address - Fax:309-799-3000
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist