Provider Demographics
NPI:1457407405
Name:LAURA C DAVIS DDS
Entity Type:Organization
Organization Name:LAURA C DAVIS DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-471-5255
Mailing Address - Street 1:875 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-8479
Mailing Address - Country:US
Mailing Address - Phone:678-407-3777
Mailing Address - Fax:
Practice Address - Street 1:875 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE 410
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-8479
Practice Address - Country:US
Practice Address - Phone:678-407-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0112381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty