Provider Demographics
NPI:1528063450
Name:ADKINSON, LAUDAN A (DMD)
Entity type:Individual
Prefix:DR
First Name:LAUDAN
Middle Name:A
Last Name:ADKINSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 PINEVIEW LAKES RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:SC
Mailing Address - Zip Code:29706
Mailing Address - Country:US
Mailing Address - Phone:803-581-6111
Mailing Address - Fax:803-581-8854
Practice Address - Street 1:726 WILSON ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:SC
Practice Address - Zip Code:29706
Practice Address - Country:US
Practice Address - Phone:803-581-2345
Practice Address - Fax:803-581-8854
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ27702Medicaid