Provider Demographics
NPI:1245442458
Name:O'SHAUGHNESSY, LARA
Entity type:Individual
Prefix:DR
First Name:LARA
Middle Name:
Last Name:O'SHAUGHNESSY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SOUTH GREELEY AVE.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHAPPAQUA
Mailing Address - State:NY
Mailing Address - Zip Code:10514
Mailing Address - Country:US
Mailing Address - Phone:914-238-0202
Mailing Address - Fax:914-238-8465
Practice Address - Street 1:1 SOUTH GREELEY AVE.
Practice Address - Street 2:SUITE 202
Practice Address - City:CHAPPAQUA
Practice Address - State:NY
Practice Address - Zip Code:10514
Practice Address - Country:US
Practice Address - Phone:914-238-0202
Practice Address - Fax:914-238-8465
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053025122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist