Healthcare Provider Details

I. General information

NPI: 1316202815
Provider Name (Legal Business Name): LAURA HERSCHDORFER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 NE 191ST ST STE 804
AVENTURA FL
33180-3387
US

IV. Provider business mailing address

2500 BISCAYNE BLVD APT 604
MIAMI FL
33137-4565
US

V. Phone/Fax

Practice location:
  • Phone: 305-466-1804
  • Fax:
Mailing address:
  • Phone: 860-983-4515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN22621
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: