Provider Demographics
NPI:1790796407
Name:LAWRENCE, LEIGHTON EUGENE (DDS)
Entity Type:Individual
Prefix:
First Name:LEIGHTON
Middle Name:EUGENE
Last Name:LAWRENCE
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:P O BOX 937
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614-0937
Mailing Address - Country:US
Mailing Address - Phone:276-935-4983
Mailing Address - Fax:276-935-4983
Practice Address - Street 1:20973 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:GRUNDY
Practice Address - State:VA
Practice Address - Zip Code:24614-0937
Practice Address - Country:US
Practice Address - Phone:276-935-4983
Practice Address - Fax:276-935-4983
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401074334122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist