Provider Demographics
NPI:1164500542
Name:PACE, LAWRENCE FRANK (D,DS)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:FRANK
Last Name:PACE
Suffix:
Gender:M
Credentials:D,DS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 N FOREST RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2159
Mailing Address - Country:US
Mailing Address - Phone:716-984-4562
Mailing Address - Fax:
Practice Address - Street 1:1613 N FOREST RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2159
Practice Address - Country:US
Practice Address - Phone:716-984-4562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030365-11223E0200X
AZD60651223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics