Provider Demographics
NPI:1811042690
Name:LAURA C DAVIS DDS
Entity Type:Organization
Organization Name:LAURA C DAVIS DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-471-5255
Mailing Address - Street 1:5370 STONE MOUNTAIN HWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3581
Mailing Address - Country:US
Mailing Address - Phone:770-413-7676
Mailing Address - Fax:770-413-7660
Practice Address - Street 1:5370 STONE MOUNTAIN HWY
Practice Address - Street 2:SUITE 140
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3581
Practice Address - Country:US
Practice Address - Phone:770-413-7676
Practice Address - Fax:770-413-7660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0112381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty