Provider Demographics
NPI:1285793927
Name:VANVARICK, LAURA A (DDS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:VANVARICK
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 1:6903 RAIN LILY RD
Mailing Address - Street 2:#201
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109
Mailing Address - Country:US
Mailing Address - Phone:239-514-1349
Mailing Address - Fax:
Practice Address - Street 1:13670 METROPOLIS AVE
Practice Address - Street 2:#102
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912
Practice Address - Country:US
Practice Address - Phone:239-768-2588
Practice Address - Fax:239-768-1448
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16614122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist