Provider Demographics
NPI:1376625830
Name:CUZALINA, LAWRENCE ANGELO (MD, DDS)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:ANGELO
Last Name:CUZALINA
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7322 E 91 ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-6016
Mailing Address - Country:US
Mailing Address - Phone:918-392-0880
Mailing Address - Fax:
Practice Address - Street 1:7322 E 91 ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-6016
Practice Address - Country:US
Practice Address - Phone:918-392-0880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK205031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery