Provider Demographics
NPI:1740851211
Name:MAXEY, LAURA ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:MAXEY
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 1:11828 RING DR STE 102
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-2106
Mailing Address - Country:US
Mailing Address - Phone:512-640-5435
Mailing Address - Fax:
Practice Address - Street 1:11828 RING DR STE 102
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-2106
Practice Address - Country:US
Practice Address - Phone:512-640-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37430122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty