Healthcare Provider Details

I. General information

NPI: 1669212700
Provider Name (Legal Business Name): NOLAN KARL LAAKSO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 NH- 108
SOMERSWORTH NH
03878
US

IV. Provider business mailing address

36 MEADOW LN
ELIOT ME
03903-2213
US

V. Phone/Fax

Practice location:
  • Phone: 603-692-9229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number05073
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: