Provider Demographics
NPI:1093900623
Name:FAMILANT, LAWRENCE JEROME (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JEROME
Last Name:FAMILANT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WEST MELLEN STREET
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23663
Mailing Address - Country:US
Mailing Address - Phone:757-722-5316
Mailing Address - Fax:
Practice Address - Street 1:18 WEST MELLEN STREET
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23663
Practice Address - Country:US
Practice Address - Phone:757-722-5316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010040841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice