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General NPI Number Information
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NPI Number | 1790901643
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Entity Type | Individual
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Provider Name | LAURENA MOORE POWELL DDS
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Gender | Female
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 01/12/2016
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Provider Practice Location Address
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Address Line | 14356 E JEFFERSON AVE
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City | DETROIT
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State | MI
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Zip | 48215-2932
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Country | US
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Telephone | 313-824-9890
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Fax | 313-824-9894
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Provider Business Mailing Address
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Address Line | 20103 ROSE FAIR CT
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City | KATY
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State | TX
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Zip | 77450-5253
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Country | US
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Telephone | 313-824-9890
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Fax | 313-824-9894
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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 | 18029
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License Number State | MI
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