Provider Demographics
NPI:1699107433
Name:GEVONY LAUGHLIN WILLIMAS DDS, PA
Entity type:Organization
Organization Name:GEVONY LAUGHLIN WILLIMAS DDS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEVONY
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-279-3803
Mailing Address - Street 1:314 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-4527
Mailing Address - Country:US
Mailing Address - Phone:828-652-2731
Mailing Address - Fax:828-652-3690
Practice Address - Street 1:314 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-4527
Practice Address - Country:US
Practice Address - Phone:828-652-2731
Practice Address - Fax:828-652-3690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-03
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC82601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty