Provider Demographics
NPI:1902038052
Name:LAURENS DENTISTRY, LLC
Entity Type:Organization
Organization Name:LAURENS DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-715-0688
Mailing Address - Street 1:810 E MAIN ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:LAURENS
Mailing Address - State:SC
Mailing Address - Zip Code:29360-3535
Mailing Address - Country:US
Mailing Address - Phone:864-715-0688
Mailing Address - Fax:
Practice Address - Street 1:810 E MAIN ST
Practice Address - Street 2:SUITE G
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-3535
Practice Address - Country:US
Practice Address - Phone:864-715-0688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4024261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4024Medicaid