Provider Demographics
NPI:1669837910
Name:LAUREL DENTAL PROPERTIES
Entity Type:Organization
Organization Name:LAUREL DENTAL PROPERTIES
Other - Org Name:PEDIATRIC DENTAL GROUP OF LAUREL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-450-6060
Mailing Address - Street 1:1925 PINE BELT DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440
Mailing Address - Country:US
Mailing Address - Phone:601-450-6060
Mailing Address - Fax:
Practice Address - Street 1:1925 PINE BELT DRIVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440
Practice Address - Country:US
Practice Address - Phone:601-450-6060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDDLETON & BELKNAP PEDIATRIC DENTISTRY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3044-981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty