Provider Demographics
NPI:1053030692
Name:KODRA, LAURENC (DMD)
Entity type:Individual
Prefix:DR
First Name:LAURENC
Middle Name:
Last Name:KODRA
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 1:2650 CEDAR SPRINGS RD APT 5530
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1477
Mailing Address - Country:US
Mailing Address - Phone:702-449-4615
Mailing Address - Fax:
Practice Address - Street 1:107 YALE ST STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-3754
Practice Address - Country:US
Practice Address - Phone:832-709-2418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX389721223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice