Provider Demographics
NPI:1659538155
Name:DRS. LAWRENCE & ROTTMAN, INC.
Entity Type:Organization
Organization Name:DRS. LAWRENCE & ROTTMAN, INC.
Other - Org Name:STATELINE ORAL & MAXILLOFACIAL SURGERY, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAWRENCDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:419-473-2707
Mailing Address - Street 1:4333 MONROE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1981
Mailing Address - Country:US
Mailing Address - Phone:419-473-2707
Mailing Address - Fax:419-473-0142
Practice Address - Street 1:4333 MONROE ST
Practice Address - Street 2:SUITE A
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1981
Practice Address - Country:US
Practice Address - Phone:419-473-2707
Practice Address - Fax:419-473-0142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-163011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty