Provider Demographics
NPI:1538458112
Name:LUX, LAURA HELEN (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:HELEN
Last Name:LUX
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:HELEN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:716 WISCONSIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE GENEVA
Mailing Address - State:WI
Mailing Address - Zip Code:53147-1826
Mailing Address - Country:US
Mailing Address - Phone:262-248-0452
Mailing Address - Fax:
Practice Address - Street 1:716 WISCONSIN ST
Practice Address - Street 2:
Practice Address - City:LAKE GENEVA
Practice Address - State:WI
Practice Address - Zip Code:53147-1826
Practice Address - Country:US
Practice Address - Phone:262-248-0452
Practice Address - Fax:262-248-0446
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6690-0151223G0001X
WI6690-151223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral Practice