Provider Demographics
NPI:1346781960
Name:GARY S. LAWHON, D.D.S.
Entity Type:Organization
Organization Name:GARY S. LAWHON, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-321-2300
Mailing Address - Street 1:707 24TH AVE SW
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-3987
Mailing Address - Country:US
Mailing Address - Phone:405-321-2300
Mailing Address - Fax:405-321-3363
Practice Address - Street 1:707 24TH AVE SW
Practice Address - Street 2:SUITE 102
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-3987
Practice Address - Country:US
Practice Address - Phone:405-321-2300
Practice Address - Fax:405-321-3363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK41671223G0001X
OK66321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty