MEDICARE: MICHAEL S LARAWAY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	25988	TX
2	1223G0001X	General Practice Dentistry	25988	TX
3	122300000X	Dentist	15615	MI

General Provider Information

NPI Number	:	1255365193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL S LARAWAY D.D.S.

Provider Business Mailing Address
First Line	:	114 VISION PARK BLVD STE 200
Second Line	:
City	:	SHENANDOAH
State	:	TX
Zip	:	77384-3008
Country	:	US
Telephone Number	:	936-321-1477
Fax Number	:	936-271-1467

Provider Business Practice Location Address
First Line	:	114 VISION PARK BLVD STE 200
Second Line	:
City	:	SHENANDOAH
State	:	TX
Zip	:	77384-3008
Country	:	US
Telephone Number	:	936-321-1477
Fax Number	:	936-271-1467

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	09/17/2025

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