Provider Demographics
NPI:1790827541
Name:DAVIS, LAURENCE DEAUBREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:DEAUBREY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11706 CONGRESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-6051
Mailing Address - Country:US
Mailing Address - Phone:317-826-0755
Mailing Address - Fax:
Practice Address - Street 1:55 S STATE AVE
Practice Address - Street 2:SUITE 3G2
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-3802
Practice Address - Country:US
Practice Address - Phone:317-972-7889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120104371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice