Provider Demographics
NPI:1649567983
Name:ASBILL, LAURA FRANKLIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:FRANKLIN
Last Name:ASBILL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LAURA
Other - Middle Name:NOELLE
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:106 CENTRAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORA
Mailing Address - State:MS
Mailing Address - Zip Code:39071-8003
Mailing Address - Country:US
Mailing Address - Phone:601-879-0031
Mailing Address - Fax:
Practice Address - Street 1:106 CENTRAL BLVD
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:MS
Practice Address - Zip Code:39071-8003
Practice Address - Country:US
Practice Address - Phone:601-879-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3604-111223G0001X
MS390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05375800Medicaid