Provider Demographics
NPI:1255514634
Name:WILLHOITE, LAURA LEA (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LEA
Last Name:WILLHOITE
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:PO BOX 925
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74018-0925
Mailing Address - Country:US
Mailing Address - Phone:918-341-5100
Mailing Address - Fax:918-342-5101
Practice Address - Street 1:1100 W BLUE STARR DR
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-2638
Practice Address - Country:US
Practice Address - Phone:918-341-5100
Practice Address - Fax:918-342-5101
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-09
Last Update Date:2007-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK51171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics