Provider Demographics
NPI:1194806349
Name:LAURIN, MARK R (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:LAURIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8301 BRIARWOOD
Mailing Address - Street 2:SU 201
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-3334
Mailing Address - Country:US
Mailing Address - Phone:907-349-6522
Mailing Address - Fax:907-349-9850
Practice Address - Street 1:8301 BRIARWOOD
Practice Address - Street 2:SU 201
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-3334
Practice Address - Country:US
Practice Address - Phone:907-349-6522
Practice Address - Fax:907-349-9850
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AKAA7491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice