Provider Demographics
NPI:1396346151
Name:OLIN, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:OLIN
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 1:702 PLEASANT VALLEY RD N APT 101
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-2554
Mailing Address - Country:US
Mailing Address - Phone:510-207-5391
Mailing Address - Fax:
Practice Address - Street 1:1000 BALD HILL RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-0506
Practice Address - Country:US
Practice Address - Phone:401-822-1866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN03526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist