Provider Demographics
NPI:1790901643
Name:MOORE POWELL, LAURENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURENA
Middle Name:
Last Name:MOORE POWELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20103 ROSE FAIR CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-5253
Mailing Address - Country:US
Mailing Address - Phone:313-824-9890
Mailing Address - Fax:313-824-9894
Practice Address - Street 1:14356 E JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48215-2932
Practice Address - Country:US
Practice Address - Phone:313-824-9890
Practice Address - Fax:313-824-9894
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI18029122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist