Provider Demographics
NPI:1013959717
Name:DE LAURENT, GUERSCHON (DDS)
Entity Type:Individual
Prefix:
First Name:GUERSCHON
Middle Name:
Last Name:DE LAURENT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2328 ARMOUR ROAD
Mailing Address - Street 2:
Mailing Address - City:NORHT KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116
Mailing Address - Country:US
Mailing Address - Phone:816-472-5660
Mailing Address - Fax:816-472-5685
Practice Address - Street 1:2328 ARMOUR ROAD
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116
Practice Address - Country:US
Practice Address - Phone:816-472-5660
Practice Address - Fax:816-472-5685
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0241251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice