MEDICARE: DR. LAURA DRIVER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2010016284	MO
2	122300000X	Dentist	4104	AR

General Provider Information

NPI Number	:	1730489451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA DRIVER DDS

Provider Business Mailing Address
First Line	:	14000 NAPOLEON RD
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-5541
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	KADENA AFB 18 MDG
Second Line	:	UNIT 5142
City	:	APO
State	:	AP
Zip	:	96368
Country	:	US
Telephone Number	:	315-630-4902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2010
Last Update Date	:	05/14/2018

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