Provider Demographics
NPI:1255365193
Name:LARAWAY, MICHAEL S (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:LARAWAY
Suffix:
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 1:114 VISION PARK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3008
Mailing Address - Country:US
Mailing Address - Phone:936-321-1477
Mailing Address - Fax:936-271-1467
Practice Address - Street 1:114 VISION PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3008
Practice Address - Country:US
Practice Address - Phone:936-321-1477
Practice Address - Fax:936-271-1467
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25988122300000X, 1223G0001X
MI15615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice