Provider Demographics
NPI:1679940720
Name:LAWSON, JARED MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:MICHAEL
Last Name:LAWSON
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 1:8805 COLUMBIA 100 PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2201
Mailing Address - Country:US
Mailing Address - Phone:410-730-2337
Mailing Address - Fax:410-730-4486
Practice Address - Street 1:8805 COLUMBIA 100 PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2201
Practice Address - Country:US
Practice Address - Phone:410-730-2337
Practice Address - Fax:410-730-4486
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD160251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice