Provider Demographics
NPI:1295830826
Name:BOVINO, LAURIE A (DMD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:A
Last Name:BOVINO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 KINDERKAMACK RD STE D
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-1600
Mailing Address - Country:US
Mailing Address - Phone:201-664-0878
Mailing Address - Fax:201-664-2234
Practice Address - Street 1:345 KINDERKAMACK RD STE D
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-1600
Practice Address - Country:US
Practice Address - Phone:201-664-0878
Practice Address - Fax:201-664-2234
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI016612001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics