Provider Demographics
NPI:1215180807
Name:LARAWAY, JOANNA I (DDS)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:I
Last Name:LARAWAY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 VISION PARK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3008
Mailing Address - Country:US
Mailing Address - Phone:936-321-1477
Mailing Address - Fax:936-271-1467
Practice Address - Street 1:114 VISION PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3008
Practice Address - Country:US
Practice Address - Phone:936-321-1477
Practice Address - Fax:936-271-1467
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17142122300000X
TX25987122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice