Provider Demographics
NPI:1720105471
Name:EDWARDS, LAURA JEAN (DDS, MS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 PLYMOUTH RD STE 302
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2552
Mailing Address - Country:US
Mailing Address - Phone:734-747-6700
Mailing Address - Fax:
Practice Address - Street 1:3250 PLYMOUTH RD STE 302
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2552
Practice Address - Country:US
Practice Address - Phone:734-747-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010183491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics