Provider Demographics
NPI:1740370394
Name:PUTMAN, LAURENCE EVERETT I (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:EVERETT
Last Name:PUTMAN
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 HAYES EDEN LN
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-7036
Mailing Address - Country:US
Mailing Address - Phone:541-672-8321
Mailing Address - Fax:541-673-0176
Practice Address - Street 1:1729 W HARVARD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2788
Practice Address - Country:US
Practice Address - Phone:541-673-0131
Practice Address - Fax:541-673-0176
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR83761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR20-1317978OtherEIN