Provider Demographics
NPI:1376165373
Name:ANDERSON, LAWRENCE BROWN II (DMD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:BROWN
Last Name:ANDERSON
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 GREENTREE RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-3550
Mailing Address - Country:US
Mailing Address - Phone:719-789-5015
Mailing Address - Fax:
Practice Address - Street 1:2601 CARVER AVE
Practice Address - Street 2:BLDG 2601
Practice Address - City:FT. GREGG-ADAMS
Practice Address - State:VA
Practice Address - Zip Code:23801
Practice Address - Country:US
Practice Address - Phone:719-789-5015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00204368122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes122300000XDental ProvidersDentist