Provider Demographics
NPI:1417950320
Name:LAWRENCE, MARTHA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:M
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 CENTER DRIVE, D7-6A, BOX 100416
Mailing Address - Street 2:UF COLLEGE OF DENTISTRY ORAL AND MAXILLOFACIAL SURGERY
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0416
Mailing Address - Country:US
Mailing Address - Phone:352-273-6750
Mailing Address - Fax:352-392-7609
Practice Address - Street 1:1395 CENTER DR # D7-6A
Practice Address - Street 2:UFCD ORAL AND MAXILLOFACIAL SURGERY, BOX 100416
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0416
Practice Address - Country:US
Practice Address - Phone:352-273-6750
Practice Address - Fax:352-392-7609
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME30651223S0112X
FLFTP5891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFTP589OtherUNIVERSITY OF FLORIDA TEACHING PERMIT
MEMM0862OtherPROVIDER NUMBER
FLFTP589OtherUNIVERSITY OF FLORIDA TEACHING PERMIT