Provider Demographics
NPI:1972574572
Name:TROMBLY, LAURA L (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:L
Last Name:TROMBLY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:L
Other - Last Name:ETTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:800 E MERRITT ISLAND CSWY
Mailing Address - Street 2:#105
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-3514
Mailing Address - Country:US
Mailing Address - Phone:321-241-5165
Mailing Address - Fax:
Practice Address - Street 1:800 E MERRITT ISLAND CSWY
Practice Address - Street 2:#105
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-3514
Practice Address - Country:US
Practice Address - Phone:321-241-5165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17046122300000X
FLDN 21148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist