Provider Demographics
NPI:1487623138
Name:MESTER, LAURENCE ROBERT JR (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:ROBERT
Last Name:MESTER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 NC 24-87
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-6808
Mailing Address - Country:US
Mailing Address - Phone:919-498-0575
Mailing Address - Fax:919-498-0519
Practice Address - Street 1:468 NC HIGHWAY 24 87
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-6808
Practice Address - Country:US
Practice Address - Phone:919-498-0575
Practice Address - Fax:919-498-0519
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC80081223G0001X, 1223G0001X
NY051306122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5913704Medicaid
NC5920796Medicaid
NC5913382Medicaid