Provider Demographics
NPI:1073820395
Name:LAWRENCE FAMILY DENTAL INC
Entity Type:Organization
Organization Name:LAWRENCE FAMILY DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-327-5151
Mailing Address - Street 1:LAWRENCE FAMILY DENTAL INC
Mailing Address - Street 2:314 ESSEX ST
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840
Mailing Address - Country:US
Mailing Address - Phone:978-327-5151
Mailing Address - Fax:978-327-5174
Practice Address - Street 1:LAWRENCE FAMILY DENTAL INC
Practice Address - Street 2:314 ESSEX ST
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840
Practice Address - Country:US
Practice Address - Phone:978-327-5151
Practice Address - Fax:978-327-5174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19904122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty