Provider Demographics
NPI:1508057761
Name:LAWRENCE F AYERS III
Entity Type:Organization
Organization Name:LAWRENCE F AYERS III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:FALES
Authorized Official - Last Name:AYERS
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-754-8809
Mailing Address - Street 1:7120 HERITAGE VILLAGE PLZ
Mailing Address - Street 2:101
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3067
Mailing Address - Country:US
Mailing Address - Phone:703-754-8809
Mailing Address - Fax:
Practice Address - Street 1:6757 LAKE DR
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20187-2546
Practice Address - Country:US
Practice Address - Phone:540-349-8694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006596122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty