Provider Demographics
NPI:1538563499
Name:VEIHDEFFER, LAURENCE WILLIAM (DMD)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:WILLIAM
Last Name:VEIHDEFFER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 W 8 ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505
Mailing Address - Country:US
Mailing Address - Phone:814-455-9194
Mailing Address - Fax:814-454-3856
Practice Address - Street 1:2021 W 8 ST.
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505
Practice Address - Country:US
Practice Address - Phone:814-455-9194
Practice Address - Fax:814-454-3856
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-21
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022411L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist