Provider Demographics
NPI:1801521844
Name:LAUREA, CARMELO TARRAZONA (DDS)
Entity type:Individual
Prefix:DR
First Name:CARMELO
Middle Name:TARRAZONA
Last Name:LAUREA
Suffix:
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 1:16926 N ALIANA RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2613
Mailing Address - Country:US
Mailing Address - Phone:281-838-6740
Mailing Address - Fax:
Practice Address - Street 1:1403 N CARTWRIGHT RD, N LOOP 336
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:936-242-4031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX385301223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice