Provider Demographics
NPI:1154434561
Name:DAVIS, LAURA BETH (DMD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:BETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2048
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36652-2048
Mailing Address - Country:US
Mailing Address - Phone:251-432-4117
Mailing Address - Fax:251-964-4012
Practice Address - Street 1:1303 DR MARTIN L KING JR AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-5341
Practice Address - Country:US
Practice Address - Phone:251-432-4117
Practice Address - Fax:251-964-4012
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL126402Medicaid
AL511-3755OtherBCBS
AL1154434561OtherNPI
AL3665OtherSTATE LICENSE
AL511-13757OtherBCBS