Healthcare Provider Details

I. General information

NPI: 1932883006
Provider Name (Legal Business Name): LAURA MAGED SAWIRES DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2023
Last Update Date: 06/09/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W LAKE MARY BLVD STE 106
LAKE MARY FL
32746-3501
US

IV. Provider business mailing address

3883 AIDEN PL
APOPKA FL
32703-6862
US

V. Phone/Fax

Practice location:
  • Phone: 407-328-6411
  • Fax:
Mailing address:
  • Phone: 407-960-9334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number28093
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: