Provider Demographics
NPI:1164412532
Name:LAWRENCE, BRYAN T (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:T
Last Name:LAWRENCE
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 1:1220 S 28TH ST
Mailing Address - Street 2:PARKLAND DENTAL CENTER
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-3402
Mailing Address - Country:US
Mailing Address - Phone:502-776-2840
Mailing Address - Fax:
Practice Address - Street 1:1220 S 28TH ST
Practice Address - Street 2:PARKLAND DENTAL CENTER
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-3402
Practice Address - Country:US
Practice Address - Phone:502-776-2840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY70631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice