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General NPI Number Information
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NPI Number | 1457407405
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Entity Type | Organization
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Legal Business Name | LAURA C DAVIS DDS
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 875 LAWRENCEVILLE SUWANEE RD SUITE 410
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-8479
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Country | US
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Telephone | 678-407-3777
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Fax |
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Provider Business Mailing Address
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Address Line | 875 LAWRENCEVILLE SUWANEE RD SUITE 410
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City | LAWRENCEVILLE
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State | GA
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Zip | 30043-8479
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Country | US
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Telephone | 678-407-3777
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Fax |
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Authorized Official
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Title or Position | OWNER/ORTHODONTIST
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Name | LAURA C DAVIS
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Credential | DDS
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Telephone | 770-471-5255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN011238
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License Number State | GA
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