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General NPI Number Information
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NPI Number | 1679004584
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Entity Type | Organization
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Legal Business Name | LAETITIA I. SERY, DDS, PLLC
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 1367 E GARRISON BLVD STE B
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City | GASTONIA
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State | NC
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Zip | 28054-5144
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Country | US
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Telephone | 980-320-8479
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Fax |
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Provider Business Mailing Address
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Address Line | 1367 E GARRISON BLVD STE B
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City | GASTONIA
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State | NC
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Zip | 28054-5144
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. LAETITIA SERY
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Credential | DDS
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Telephone | 704-860-0945
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 8474
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License Number State | NC
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