Individual
MS. LAURYN ELIZABETH GRESHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6323 N FRESNO ST STE 101, FRESNO, CA 93710-5282
(559) 439-2307
Mailing address
34697 ROAD 221 WISHON CA 93669, P.O. BOX 852, NORTH FORK CA, CALIFORNIA 93643
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
91009
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D8733126
NON MEDICARE
CA
Enumeration date
01/14/2019
Last updated
01/14/2019
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