Provider Demographics
NPI:1629557178
Name:LAWRENCE SMILE DESIGN LLC
Entity Type:Organization
Organization Name:LAWRENCE SMILE DESIGN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWER
Authorized Official - Prefix:DR
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:978-989-9988
Mailing Address - Street 1:171 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1426
Mailing Address - Country:US
Mailing Address - Phone:978-989-9988
Mailing Address - Fax:
Practice Address - Street 1:171 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1426
Practice Address - Country:US
Practice Address - Phone:978-989-9988
Practice Address - Fax:978-989-9088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-07
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856884122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty