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General NPI Number Information
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NPI Number | 1720490238
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Entity Type | Individual
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Provider Name | LAURA PHELPS D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 06/02/2014
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 112 HARMON LN STE A
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City | KERNERSVILLE
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State | NC
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Zip | 27284
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Country | US
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Telephone | 336-993-3751
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Fax |
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Provider Business Mailing Address
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Address Line | 112 HARMON LN STE A
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City | KERNERSVILLE
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State | NC
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Zip | 27284-3478
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Country | US
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Telephone | 336-993-3751
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9756
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License Number State | NC
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