Provider Demographics
NPI:1710196852
Name:TRUDGEON, LAWRENCE S (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:S
Last Name:TRUDGEON
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 1:10550 SEPULVEDA BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1934
Mailing Address - Country:US
Mailing Address - Phone:818-365-6339
Mailing Address - Fax:818-361-6684
Practice Address - Street 1:10550 SEPULVEDA BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1934
Practice Address - Country:US
Practice Address - Phone:818-365-6339
Practice Address - Fax:818-361-6684
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23049OtherSTATE LICENSE