Provider Demographics
NPI:1558490847
Name:LAWRENCE ABRAHAM AMSTERDAM DMD PA
Entity Type:Organization
Organization Name:LAWRENCE ABRAHAM AMSTERDAM DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ABRAHAM
Authorized Official - Last Name:AMSTERDAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-574-1555
Mailing Address - Street 1:1528 COUNTRY RIDGE LANE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21221-3906
Mailing Address - Country:US
Mailing Address - Phone:410-574-1555
Mailing Address - Fax:410-574-8483
Practice Address - Street 1:1528 COUNTRY RIDGE LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21221-3906
Practice Address - Country:US
Practice Address - Phone:410-574-1555
Practice Address - Fax:410-574-8483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty