Provider Demographics
NPI:1588788707
Name:PERELL, LAURA A (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:A
Last Name:PERELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:521 E JOPPA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5419
Mailing Address - Country:US
Mailing Address - Phone:410-828-4544
Mailing Address - Fax:410-828-4544
Practice Address - Street 1:521 E JOPPA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5419
Practice Address - Country:US
Practice Address - Phone:410-828-4544
Practice Address - Fax:410-828-4544
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD99831223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDV450OtherBLUE SHIELD OF MD