Provider Demographics
NPI:1407238322
Name:PEDIGO, LAURA ASHLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ASHLEY
Last Name:PEDIGO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAGNOLIA FARMS WAY
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-7592
Mailing Address - Country:US
Mailing Address - Phone:864-844-4039
Mailing Address - Fax:
Practice Address - Street 1:1 MEMORIAL MEDICAL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4407
Practice Address - Country:US
Practice Address - Phone:864-351-2400
Practice Address - Fax:864-351-2420
Is Sole Proprietor?:No
Enumeration Date:2015-06-27
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8572122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist