Provider Demographics
NPI:1598848350
Name:AKINOLA, LAURIE (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:AKINOLA
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 1:4051 HWY 78
Mailing Address - Street 2:SUITE F101
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-8424
Mailing Address - Country:US
Mailing Address - Phone:678-691-9064
Mailing Address - Fax:678-691-9425
Practice Address - Street 1:4051 HWY 78
Practice Address - Street 2:SUITE F101
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-8424
Practice Address - Country:US
Practice Address - Phone:678-691-9064
Practice Address - Fax:678-691-9425
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0113671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA552305298GMedicaid