Provider Demographics
NPI:1689368698
Name:LAWLER FAMILY DENTISTRY HAYWARD
Entity Type:Organization
Organization Name:LAWLER FAMILY DENTISTRY HAYWARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUEANE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:NOVACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-374-2856
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:LAKE NEBAGAMON
Mailing Address - State:WI
Mailing Address - Zip Code:54849-0520
Mailing Address - Country:US
Mailing Address - Phone:715-374-2856
Mailing Address - Fax:715-374-2299
Practice Address - Street 1:10541 N RANCH RD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-6462
Practice Address - Country:US
Practice Address - Phone:715-634-2011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty