Provider Demographics
NPI:1225044670
Name:LORSON, EDWARD LAWRENCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LAWRENCE
Last Name:LORSON
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 1:2814 NORTHGATE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245-9568
Mailing Address - Country:US
Mailing Address - Phone:319-338-5484
Mailing Address - Fax:319-338-9413
Practice Address - Street 1:2814 NORTHGATE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-9568
Practice Address - Country:US
Practice Address - Phone:319-338-5484
Practice Address - Fax:319-338-9413
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA058461223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0142554Medicaid
T00866Medicare UPIN
I15367Medicare ID - Type Unspecified