Provider Demographics
NPI:1568501278
Name:WARECK, LAWRENCE A (DDS)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:A
Last Name:WARECK
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 1:1598 PIKE ROAD
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840
Mailing Address - Country:US
Mailing Address - Phone:517-339-3801
Mailing Address - Fax:
Practice Address - Street 1:601 S. GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48933
Practice Address - Country:US
Practice Address - Phone:517-485-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010133381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice