Provider Demographics
NPI:1487657946
Name:COVIN, LAWRENCE HAROLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:HAROLD
Last Name:COVIN
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 1:8011 MINNETONKA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-3019
Mailing Address - Country:US
Mailing Address - Phone:952-935-4428
Mailing Address - Fax:952-544-4162
Practice Address - Street 1:8011 MINNETONKA BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-3019
Practice Address - Country:US
Practice Address - Phone:952-935-4428
Practice Address - Fax:952-544-4162
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND63111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice