Provider Demographics
NPI:1255634499
Name:SOCIAS, LAURA MERCEDES (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:MERCEDES
Last Name:SOCIAS
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 1:10401 W LINCOLN AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-1255
Mailing Address - Country:US
Mailing Address - Phone:414-545-5380
Mailing Address - Fax:414-545-0622
Practice Address - Street 1:10401 W LINCOLN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-1255
Practice Address - Country:US
Practice Address - Phone:414-545-5380
Practice Address - Fax:414-545-0622
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-09
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6635-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist