Provider Demographics
NPI:1457313694
Name:LAWRENCE MAHER, III, D.D.S AND GAYLA M MAHER, D.D.S., INC.
Entity Type:Organization
Organization Name:LAWRENCE MAHER, III, D.D.S AND GAYLA M MAHER, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHER
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-471-1797
Mailing Address - Street 1:505 W FAIRMONT PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-6312
Mailing Address - Country:US
Mailing Address - Phone:281-471-1797
Mailing Address - Fax:281-471-6339
Practice Address - Street 1:505 W FAIRMONT PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-6312
Practice Address - Country:US
Practice Address - Phone:281-471-1797
Practice Address - Fax:281-471-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental