Provider Demographics
NPI:1013172618
Name:PRICHARD, LAUREL ALAINE (DDS)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:ALAINE
Last Name:PRICHARD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:ALAINE
Other - Last Name:SPARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 681
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-0681
Mailing Address - Country:US
Mailing Address - Phone:417-831-0150
Mailing Address - Fax:417-831-0155
Practice Address - Street 1:618 N BENTON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-1102
Practice Address - Country:US
Practice Address - Phone:417-831-0150
Practice Address - Fax:417-831-0155
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008018262122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist