Provider Demographics
NPI:1912225996
Name:LAURENCE R. MESTER, JR. DDS & ASSOCIATES PA
Entity Type:Organization
Organization Name:LAURENCE R. MESTER, JR. DDS & ASSOCIATES PA
Other - Org Name:CAROLINA LAKES FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MESTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-498-0575
Mailing Address - Street 1:468 NC 24-87
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-6808
Mailing Address - Country:US
Mailing Address - Phone:919-498-0575
Mailing Address - Fax:919-498-0519
Practice Address - Street 1:468 NC HIGHWAY 24 87
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-6808
Practice Address - Country:US
Practice Address - Phone:919-498-0575
Practice Address - Fax:919-498-0519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913704Medicaid