Provider Demographics
NPI:1447371356
Name:LAUER, MARY CATHERINE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:CATHERINE
Last Name:LAUER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2571 SAYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4703
Mailing Address - Country:US
Mailing Address - Phone:216-932-0548
Mailing Address - Fax:
Practice Address - Street 1:2571 SAYBROOK RD
Practice Address - Street 2:
Practice Address - City:UNIVERSITY HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-4703
Practice Address - Country:US
Practice Address - Phone:216-932-0548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-017941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0606008Medicaid