| NPI | 1578856514 |
|---|---|
| Former Name | LAURI NICHOLE BREAUD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 6151) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 6151) |
| 122300000X Dentist (Licence: AL 5889 C1) | |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2022-04-07 |