Provider Demographics
NPI:1255365193
Name:LARAWAY, MICHAEL S (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:LARAWAY
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 1:410 E LUDINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2123
Mailing Address - Country:US
Mailing Address - Phone:231-843-9810
Mailing Address - Fax:231-845-9152
Practice Address - Street 1:410 E LUDINGTON AVE
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2123
Practice Address - Country:US
Practice Address - Phone:231-843-9810
Practice Address - Fax:231-845-9152
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist