Provider Demographics
NPI:1891977310
Name:LASER DENTISTRY, INC.
Entity Type:Organization
Organization Name:LASER DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:MONICA
Authorized Official - Last Name:CORKE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:239-936-5442
Mailing Address - Street 1:1550 MATTHEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1733
Mailing Address - Country:US
Mailing Address - Phone:239-936-5442
Mailing Address - Fax:239-936-4478
Practice Address - Street 1:1550 MATTHEW DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1733
Practice Address - Country:US
Practice Address - Phone:239-936-5442
Practice Address - Fax:239-936-4478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14551122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty