Provider Demographics
NPI:1891432001
Name:LAWLIS, THOMAS JACOB (DDS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JACOB
Last Name:LAWLIS
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 1:924 E MORRISON DR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-1937
Mailing Address - Country:US
Mailing Address - Phone:620-262-6077
Mailing Address - Fax:
Practice Address - Street 1:1431 S BLUFFVIEW DR
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-3010
Practice Address - Country:US
Practice Address - Phone:316-686-7155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61889122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program