Provider Demographics
NPI:1790870202
Name:KLEINSCHMIDT, LAURA PITTMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:PITTMAN
Last Name:KLEINSCHMIDT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:656 INDIAN TRAIL ROAD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-6872
Mailing Address - Country:US
Mailing Address - Phone:770-806-9090
Mailing Address - Fax:770-806-8188
Practice Address - Street 1:656 INDIAN TRAIL ROAD
Practice Address - Street 2:SUITE 209
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-6872
Practice Address - Country:US
Practice Address - Phone:770-806-9090
Practice Address - Fax:770-806-8188
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GADN0099631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice