Healthcare Provider Details

I. General information

NPI: 1396955753
Provider Name (Legal Business Name): LAURA LANEY CERTIFIED XRAY TECH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 E THOMAS RD SUITE 102
SCOTTSDALE AZ
85251-5844
US

IV. Provider business mailing address

8111 E THOMAS RD SUITE 102
SCOTTSDALE AZ
85251-5844
US

V. Phone/Fax

Practice location:
  • Phone: 480-947-3727
  • Fax: 480-947-6201
Mailing address:
  • Phone: 480-947-3727
  • Fax: 480-947-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126900000X
TaxonomyDental Laboratory Technician
License Number7-D-3223
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: