Provider Demographics
NPI:1073928412
Name:MERIWETHER, LAUREL AYRES (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:AYRES
Last Name:MERIWETHER
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 1:1416 BELMEADE PL
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2032
Mailing Address - Country:US
Mailing Address - Phone:731-217-0280
Mailing Address - Fax:
Practice Address - Street 1:801 SUNSET DR
Practice Address - Street 2:BUILDING A, SUITE 3
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3033
Practice Address - Country:US
Practice Address - Phone:423-610-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.3426122300000X
TN101821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist