Provider Demographics
NPI:1730280280
Name:DAVIS, LAWRENCE HUEBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:HUEBERT
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:LARRY
Other - Middle Name:HUEBER
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:3001 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4814
Mailing Address - Country:US
Mailing Address - Phone:316-685-9791
Mailing Address - Fax:316-685-6319
Practice Address - Street 1:3001 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4814
Practice Address - Country:US
Practice Address - Phone:316-685-9791
Practice Address - Fax:316-685-6319
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS58081223G0001X
MO0142071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100222490BMedicaid
KS019212OtherBLUE CROSS BLUE SHIELD
KS019212OtherBLUE CROSS BLUE SHIELD