Provider Demographics
NPI:1366622987
Name:EMMOTT, LAWRENCE FIELDING (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:FIELDING
Last Name:EMMOTT
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 1:727 E BETHANY HOME RD
Mailing Address - Street 2:A-100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2198
Mailing Address - Country:US
Mailing Address - Phone:602-279-1641
Mailing Address - Fax:602-279-1507
Practice Address - Street 1:727 E BETHANY HOME RD
Practice Address - Street 2:A-100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2198
Practice Address - Country:US
Practice Address - Phone:602-279-1641
Practice Address - Fax:602-279-1507
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist