Provider Demographics
NPI:1366758625
Name:PIROUTEK, LAURA ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:PIROUTEK
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 1:100 E. VALENCIA MESA DRIVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3800
Mailing Address - Country:US
Mailing Address - Phone:714-462-4680
Mailing Address - Fax:714-644-8220
Practice Address - Street 1:100 E VALENCIA MESA DR
Practice Address - Street 2:SUITE 306
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3813
Practice Address - Country:US
Practice Address - Phone:714-462-4680
Practice Address - Fax:714-644-8220
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA614251223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics