Provider Demographics
NPI:1235829409
Name:COO, LAURA M (DDS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:COO
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 1:1616 13TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3800
Mailing Address - Country:US
Mailing Address - Phone:304-691-1247
Mailing Address - Fax:
Practice Address - Street 1:1616 13TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3800
Practice Address - Country:US
Practice Address - Phone:304-691-1247
Practice Address - Fax:304-691-1248
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4807122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist