Provider Demographics
NPI:1750418588
Name:UNDRAITIS, LAURA ANTHONIA (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANTHONIA
Last Name:UNDRAITIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANTHONIA
Other - Last Name:RADDATZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:195 COMMONS LOOP A- MONTANA DENTAL DESIGNS
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1912
Mailing Address - Country:US
Mailing Address - Phone:406-755-5280
Mailing Address - Fax:406-752-7679
Practice Address - Street 1:195 COMMONS LOOP A- MONTANA DENTAL DESIGNS
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1912
Practice Address - Country:US
Practice Address - Phone:406-755-5280
Practice Address - Fax:406-752-7679
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19791223D0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health