MEDICARE: DR. LAURA M GUSHUE D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	19711	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3579	OTHER	OH	DORAL
2	341957404065	OTHER	OH	CARESOURE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750355343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA M GUSHUE D.M.D.

Provider Business Mailing Address
First Line	:	6928 RYAN RD
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-8878
Country	:	US
Telephone Number	:	330-725-7488
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 LIVINGSTON AVE
Second Line	:	LORAIN COUNTY HEALTH AND DENTISTRY
City	:	LORAIN
State	:	OH
Zip	:	44052
Country	:	US
Telephone Number	:	440-233-0100
Fax Number	:	440-242-2400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	12/01/2009

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