Provider Demographics
NPI:1235310608
Name:HANCOCK JONES, LAURA B (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:B
Last Name:HANCOCK JONES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:B
Other - Last Name:HANCOCK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:114 N BRADY ST
Mailing Address - Street 2:
Mailing Address - City:MORGANFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42437-1502
Mailing Address - Country:US
Mailing Address - Phone:270-389-2290
Mailing Address - Fax:270-389-9166
Practice Address - Street 1:114 N BRADY ST
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437-1502
Practice Address - Country:US
Practice Address - Phone:270-389-2290
Practice Address - Fax:270-389-9166
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7949122300000X, 1223D0001X, 1223P0221X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No1223D0001XDental ProvidersDentistDental Public Health
No1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100052080Medicaid