Provider Demographics
NPI:1578818555
Name:MOSES SMALLEY, LAURA PAIGE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:PAIGE
Last Name:MOSES SMALLEY
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 1:1930 ALCOA HWY BLDG A
Mailing Address - Street 2:SUITE 340
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1500
Mailing Address - Country:US
Mailing Address - Phone:865-305-9440
Mailing Address - Fax:865-305-9442
Practice Address - Street 1:1930 ALCOA HWY BLDG A
Practice Address - Street 2:SUITE 340
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1500
Practice Address - Country:US
Practice Address - Phone:865-305-9440
Practice Address - Fax:865-305-9442
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program