Provider Demographics
NPI:1487124905
Name:HARBAUGH, LAURA RENEE (LD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:RENEE
Last Name:HARBAUGH
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8623 187TH AVENUE CT NW
Mailing Address - Street 2:
Mailing Address - City:VAUGHN
Mailing Address - State:WA
Mailing Address - Zip Code:98394-9723
Mailing Address - Country:US
Mailing Address - Phone:253-432-9606
Mailing Address - Fax:
Practice Address - Street 1:5800 SOUNDVIEW DR STE A102
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-2057
Practice Address - Country:US
Practice Address - Phone:208-403-9694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60867088122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist