Provider Demographics
NPI:1396849030
Name:MARPLE, LAURA LOU (DDS)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LOU
Last Name:MARPLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:LOU
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:304 RIVERVIEW DR
Mailing Address - Street 2:PO BOX 485
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601
Mailing Address - Country:US
Mailing Address - Phone:304-765-2522
Mailing Address - Fax:304-765-2622
Practice Address - Street 1:304 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601
Practice Address - Country:US
Practice Address - Phone:304-765-2522
Practice Address - Fax:304-765-2122
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0136378000Medicaid