Provider Demographics
NPI:1265562268
Name:MCLAURIN, SAMUEL HUGH JR (DMD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:HUGH
Last Name:MCLAURIN
Suffix:JR
Gender:M
Credentials:DMD
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 92
Mailing Address - Street 2:
Mailing Address - City:BAY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39422-0092
Mailing Address - Country:US
Mailing Address - Phone:601-764-4111
Mailing Address - Fax:601-764-3443
Practice Address - Street 1:10 S SIXTH ST
Practice Address - Street 2:
Practice Address - City:BAY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39422-9055
Practice Address - Country:US
Practice Address - Phone:601-764-4111
Practice Address - Fax:601-764-3443
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2880951223G0001X
MS2880-95122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice