Provider Demographics
NPI:1477845600
Name:LAWLOR, MICHAEL EUGENE (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EUGENE
Last Name:LAWLOR
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 1:239 SEAL BEACH BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-8783
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:239 SEAL BEACH BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-8783
Practice Address - Country:US
Practice Address - Phone:562-430-4851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA287461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice