Provider Demographics
NPI:1770510851
Name:LAWSON, BRENT C (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:C
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 1:308 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WHITEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28472-3714
Mailing Address - Country:US
Mailing Address - Phone:910-642-6001
Mailing Address - Fax:910-642-9799
Practice Address - Street 1:308 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3714
Practice Address - Country:US
Practice Address - Phone:910-642-6001
Practice Address - Fax:910-642-9799
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK8990039Medicaid