Provider Demographics
NPI:1063585602
Name:LAUB, ALAN L (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:L
Last Name:LAUB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 BONNELL ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-3248
Mailing Address - Country:US
Mailing Address - Phone:513-563-6936
Mailing Address - Fax:513-563-1008
Practice Address - Street 1:1100 BONNELL ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-3248
Practice Address - Country:US
Practice Address - Phone:513-563-6936
Practice Address - Fax:513-563-1008
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17372122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist