Provider Demographics
NPI:1932133121
Name:MAULDIN, LAURA VIRGINIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:VIRGINIA
Last Name:MAULDIN
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 1:701 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3313
Mailing Address - Country:US
Mailing Address - Phone:704-982-6312
Mailing Address - Fax:704-983-7951
Practice Address - Street 1:701 N 2ND ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3313
Practice Address - Country:US
Practice Address - Phone:704-982-6312
Practice Address - Fax:704-983-7951
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC59131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02614OtherBLUE CROSS
NC8995562Medicaid
NC8995562Medicaid