Individual
MRS. LAURA CHANNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
15910 W COMPANY LAKE RD, HAYWARD, WI 54843-5320
(715) 934-2224
(715) 934-5740
Mailing address
15910 W COMPANY LAKE RD, HAYWARD, WI 54843-5320
(715) 934-2224
(715) 934-5740
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1223G0001X
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1205120102
—
WI
Enumeration date
06/08/2011
Last updated
12/07/2011
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