Provider Demographics
NPI:1659491736
Name:LAWRENCE S MINTZER DDS PLLC
Entity Type:Organization
Organization Name:LAWRENCE S MINTZER DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:SERLIN
Authorized Official - Last Name:MINTZER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-274-5060
Mailing Address - Street 1:23100 CHERRY HILL RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:313-274-5060
Mailing Address - Fax:313-274-8840
Practice Address - Street 1:23100 CHERRY HILL RD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-274-5060
Practice Address - Fax:313-274-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901010768122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty