Provider Demographics
NPI:1255409561
Name:PANDY, LAURA ILONA (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ILONA
Last Name:PANDY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33398 WALKER RD
Mailing Address - Street 2:UNIT E
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-1496
Mailing Address - Country:US
Mailing Address - Phone:440-933-2710
Mailing Address - Fax:440-933-2834
Practice Address - Street 1:33398 WALKER RD
Practice Address - Street 2:UNIT E
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-1496
Practice Address - Country:US
Practice Address - Phone:440-933-2710
Practice Address - Fax:440-933-2834
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-82631223G0001X
PADS027610L1223G0001X
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice