Provider Demographics
NPI:1871695528
Name:FORD, LAURIE C (DMD)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:C
Last Name:FORD
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:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-0316
Mailing Address - Country:US
Mailing Address - Phone:502-538-8881
Mailing Address - Fax:502-416-0748
Practice Address - Street 1:6442 HIGHWAY 44 E STE 140
Practice Address - Street 2:
Practice Address - City:MT WASHINGTON
Practice Address - State:KY
Practice Address - Zip Code:40047-6707
Practice Address - Country:US
Practice Address - Phone:502-538-8881
Practice Address - Fax:502-416-0748
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8412122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100144730Medicaid