Provider Demographics
NPI:1265582506
Name:ADAIR, LAURA BLAKE (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:BLAKE
Last Name:ADAIR
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 1262
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-1262
Mailing Address - Country:US
Mailing Address - Phone:512-858-5243
Mailing Address - Fax:512-858-9804
Practice Address - Street 1:2150 HWY. 290 EAST
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620
Practice Address - Country:US
Practice Address - Phone:512-858-5243
Practice Address - Fax:512-858-9804
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice