Healthcare Provider Details

I. General information

NPI: 1265527816
Provider Name (Legal Business Name): LAURA LYNN TESTA RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER ROAD
GAINESVILLE FL
32608
US

IV. Provider business mailing address

2014 NE 7TH STREET
GAINESVILLE FL
32609
US

V. Phone/Fax

Practice location:
  • Phone: 352-379-4040
  • Fax:
Mailing address:
  • Phone: 352-339-0047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number15714
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: