Provider Demographics
NPI:1487024253
Name:TWIFORD-CARLOS, LAURA (RDH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:TWIFORD-CARLOS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:TWIFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:36000 SHOEMAKER LANE
Mailing Address - Street 2:SUITE 1051
Mailing Address - City:FT. CAVASOS
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:252-548-4741
Mailing Address - Fax:
Practice Address - Street 1:36000 SHOEMAKER LANE
Practice Address - Street 2:SUITE 1051
Practice Address - City:FT. CAVASOS
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:252-548-4741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10200124Q00000X
VA0402206301124Q00000X
NJ00887300124Q00000X
NY0273531124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist