Provider Demographics
NPI:1114008679
Name:WEIR, LAWRENCE THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:THOMAS
Last Name:WEIR
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 1:113 WAPPOO CREEK DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2136
Mailing Address - Country:US
Mailing Address - Phone:843-762-1234
Mailing Address - Fax:843-762-9142
Practice Address - Street 1:113 WAPPOO CREEK DR
Practice Address - Street 2:SUITE 5
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-2136
Practice Address - Country:US
Practice Address - Phone:843-762-1234
Practice Address - Fax:843-762-9142
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice