Provider Demographics
NPI:1871806612
Name:AZANGUE, LAURIANT (DMD)
Entity type:Individual
Prefix:DR
First Name:LAURIANT
Middle Name:
Last Name:AZANGUE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 TEATICKET CT
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-5790
Mailing Address - Country:US
Mailing Address - Phone:612-481-2399
Mailing Address - Fax:
Practice Address - Street 1:209 TEATICKET CT
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-5790
Practice Address - Country:US
Practice Address - Phone:612-481-2399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice