Provider Demographics
NPI:1710067855
Name:MAST, LAWRENCE EUGENE (DDS MSD PS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:EUGENE
Last Name:MAST
Suffix:
Gender:M
Credentials:DDS MSD PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 112 AVE NE #A
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-2939
Mailing Address - Country:US
Mailing Address - Phone:425-455-0784
Mailing Address - Fax:425-451-3999
Practice Address - Street 1:2150 112 AVE NE #A
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-2939
Practice Address - Country:US
Practice Address - Phone:425-455-0784
Practice Address - Fax:425-451-3999
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA42331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5390802Medicaid
WA5018171Medicaid