Healthcare Provider Details

I. General information

NPI: 1437776218
Provider Name (Legal Business Name): LAURA C DAZA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 WINTER ST STE 201
ROCHESTER NH
03867-3139
US

IV. Provider business mailing address

40 WINTER ST STE 201
ROCHESTER NH
03867-3139
US

V. Phone/Fax

Practice location:
  • Phone: 603-332-7300
  • Fax:
Mailing address:
  • Phone: 603-332-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number04571
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number04571
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: