Provider Demographics
NPI:1679004584
Name:LAETITIA I. SERY, DDS, PLLC
Entity Type:Organization
Organization Name:LAETITIA I. SERY, DDS, PLLC
Other - Org Name:GASTONIA PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAETITIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SERY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-860-0945
Mailing Address - Street 1:1367 E GARRISON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5144
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1367 E GARRISON BLVD STE B
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5144
Practice Address - Country:US
Practice Address - Phone:980-320-8479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC84741223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty