Provider Demographics
NPI:1134282288
Name:LARRY D. LAWSON DDS PA
Entity Type:Organization
Organization Name:LARRY D. LAWSON DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:864-366-9511
Mailing Address - Street 1:308 WASHINGTON ST
Mailing Address - Street 2:PO BOX 905
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-1833
Mailing Address - Country:US
Mailing Address - Phone:864-366-5511
Mailing Address - Fax:864-366-2232
Practice Address - Street 1:308 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-1833
Practice Address - Country:US
Practice Address - Phone:864-366-5511
Practice Address - Fax:864-366-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC15961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9542Medicaid