Provider Demographics
NPI:1356754402
Name:GART, LAURA PAIGE (DMD, MS)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:PAIGE
Last Name:GART
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S GREENLEAF ST STE 203
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5708
Mailing Address - Country:US
Mailing Address - Phone:847-623-5915
Mailing Address - Fax:847-623-1174
Practice Address - Street 1:310 S GREENLEAF ST STE 203
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5708
Practice Address - Country:US
Practice Address - Phone:847-623-5915
Practice Address - Fax:847-623-1174
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN239871223S0112X
390200000X
IL319.0192761223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program