Provider Demographics
NPI:1083379994
Name:SUNDMARK, LAURA DAWN (BA, DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:DAWN
Last Name:SUNDMARK
Suffix:
Gender:F
Credentials:BA, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3420 WOODFORD CIR APT 18
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2658
Mailing Address - Country:US
Mailing Address - Phone:651-263-1786
Mailing Address - Fax:
Practice Address - Street 1:600 EXECUTIVE PL
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5124
Practice Address - Country:US
Practice Address - Phone:910-484-6145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC122551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice