=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396746251
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHAN CHARLES LAUGHREY DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2005
-----------------------------------------------------
Last Update Date | 11/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 E NORTH AVE SUITE 108 AGH DEPT OF DENTISTRY
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15212-4756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-359-6001
-----------------------------------------------------
Fax | 412-359-4063
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 320 E NORTH AVE SUITE 108 AGH DEPT OF DENTISTRY
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15212-4756
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-359-6001
-----------------------------------------------------
Fax | 412-359-4063
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DS030849L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------