Provider Demographics
NPI:1750355343
Name:GUSHUE, LAURA M (DMD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:GUSHUE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6928 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-8878
Mailing Address - Country:US
Mailing Address - Phone:330-725-7488
Mailing Address - Fax:
Practice Address - Street 1:1800 LIVINGSTON AVE
Practice Address - Street 2:LORAIN COUNTY HEALTH AND DENTISTRY
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052
Practice Address - Country:US
Practice Address - Phone:440-233-0100
Practice Address - Fax:440-242-2400
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19711122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3579OtherDORAL
OH341957404065OtherCARESOURE
OH0952689Medicaid