Provider Demographics
NPI:1821204132
Name:DANTZLER, LAURA BANNER (RDH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:BANNER
Last Name:DANTZLER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 1ST BEND RD
Mailing Address - Street 2:
Mailing Address - City:HARLEYVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29448-3301
Mailing Address - Country:US
Mailing Address - Phone:843-560-0601
Mailing Address - Fax:
Practice Address - Street 1:100 OLD CHEROKEE RD
Practice Address - Street 2:SUITE F, PMB 14
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-9316
Practice Address - Country:US
Practice Address - Phone:803-808-2950
Practice Address - Fax:803-808-5642
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3945124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist