Provider Demographics
NPI:1821172610
Name:AMENTA, LAWRENCE JOHN (DMD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:JOHN
Last Name:AMENTA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7435 WEST RIDGE RD
Mailing Address - Street 2:BOX 496
Mailing Address - City:FARIVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415
Mailing Address - Country:US
Mailing Address - Phone:814-474-2620
Mailing Address - Fax:814-474-3399
Practice Address - Street 1:7435 WEST RIDGE RD
Practice Address - Street 2:BOX 496
Practice Address - City:FARIVIEW
Practice Address - State:PA
Practice Address - Zip Code:16415
Practice Address - Country:US
Practice Address - Phone:814-474-2620
Practice Address - Fax:814-474-3399
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS016105122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist