Provider Demographics
NPI:1316195043
Name:LAWRENCE, ROBERTA G (RDHAP)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:G
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12340 SEAL BEACH BLVD
Mailing Address - Street 2:SUITE B-317
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2792
Mailing Address - Country:US
Mailing Address - Phone:714-875-1150
Mailing Address - Fax:
Practice Address - Street 1:4232 GREEN AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3545
Practice Address - Country:US
Practice Address - Phone:562-430-8244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA216124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist