Provider Demographics
NPI:1306278429
Name:LAURA MARPLE DDS
Entity type:Organization
Organization Name:LAURA MARPLE DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARPLE
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:304-765-2522
Mailing Address - Street 1:304 RIVERVIEW DR
Mailing Address - Street 2:PO BOX 485
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601-1343
Mailing Address - Country:US
Mailing Address - Phone:304-765-2522
Mailing Address - Fax:304-765-2622
Practice Address - Street 1:304 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:SUTTON
Practice Address - State:WV
Practice Address - Zip Code:26601-1343
Practice Address - Country:US
Practice Address - Phone:304-765-2522
Practice Address - Fax:304-765-2622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV40641223G0001X
WV24941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0136378000Medicaid