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General NPI Number Information
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NPI Number | 1780273524
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Entity Type | Individual
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Provider Name | LAURA KATHERINE NADER MEHANNY
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Gender | Female
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Dates
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Enumeration Date | 01/15/2021
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 2120 RAILROAD AVE
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City | PITTSBURG
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State | CA
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Zip | 94565-4880
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Country | US
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Telephone | 925-203-3079
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Fax |
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Provider Business Mailing Address
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Address Line | 798 VALLEY GREEN DR
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City | BRENTWOOD
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State | CA
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Zip | 94513-1467
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 105906
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License Number State | CA
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