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General NPI Number Information
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NPI Number | 1538458112
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Entity Type | Individual
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Provider Name | LAURA HELEN LUX D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 716 WISCONSIN ST
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City | LAKE GENEVA
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State | WI
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Zip | 53147-1826
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Country | US
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Telephone | 262-248-0452
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Fax | 262-248-0446
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Provider Business Mailing Address
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Address Line | 716 WISCONSIN ST
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City | LAKE GENEVA
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State | WI
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Zip | 53147-1826
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Country | US
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Telephone | 262-248-0452
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6690-015
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 6690-15
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License Number State | WI
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