MEDICARE: DR. LAURENCE DEAUBREY DAVIS D.D.S

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	1223G0001X	General Practice Dentistry	12010437	IN

General Provider Information

NPI Number	:	1790827541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURENCE DEAUBREY DAVIS D.D.S

Provider Business Mailing Address
First Line	:	11706 CONGRESSIONAL CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-6051
Country	:	US
Telephone Number	:	317-826-0755
Fax Number	:

Provider Business Practice Location Address
First Line	:	55 S STATE AVE
Second Line	:	SUITE 3G2
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3802
Country	:	US
Telephone Number	:	317-972-7889
Fax Number	:

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/08/2007

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