Provider Demographics
NPI:1033391230
Name:LAWRENCE H. BECK, D.D.S. INC
Entity Type:Organization
Organization Name:LAWRENCE H. BECK, D.D.S. INC
Other - Org Name:LAKEVIEW ORAL SURGERY & DENTAL IMPLANT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ORAL MAXILLOFACIAL SURGEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURIZIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRABELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-985-3200
Mailing Address - Street 1:1903 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3105
Mailing Address - Country:US
Mailing Address - Phone:810-985-3200
Mailing Address - Fax:810-985-3752
Practice Address - Street 1:1903 10TH AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3105
Practice Address - Country:US
Practice Address - Phone:810-985-3200
Practice Address - Fax:810-985-3752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010164431223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION98840Medicare PIN