Provider Demographics
NPI:1558770024
Name:MILLER, LAWRENCE C (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:C
Last Name:MILLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 STATE RD
Mailing Address - Street 2:PO BOX 905
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1830
Mailing Address - Country:US
Mailing Address - Phone:610-644-5547
Mailing Address - Fax:610-644-1081
Practice Address - Street 1:22 STATE RD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1830
Practice Address - Country:US
Practice Address - Phone:610-644-5547
Practice Address - Fax:610-644-1081
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-0195521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice