Provider Demographics
NPI:1629264585
Name:PAUL, LAWRENCE JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JAY
Last Name:PAUL
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 1:4 COTTONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-2325
Mailing Address - Country:US
Mailing Address - Phone:610-564-4898
Mailing Address - Fax:
Practice Address - Street 1:4 COTTONWOOD CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-2325
Practice Address - Country:US
Practice Address - Phone:610-564-4898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-023790-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101904982001Medicaid