Provider Demographics
NPI:1730376294
Name:DACKS, LAURA MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MICHELLE
Last Name:DACKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 HUNDRED OAKS PKWY
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-8192
Mailing Address - Country:US
Mailing Address - Phone:423-741-6141
Mailing Address - Fax:
Practice Address - Street 1:266 HUNDRED OAKS PKWY
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-8192
Practice Address - Country:US
Practice Address - Phone:423-741-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13871208600000X
SC51590208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery