Provider Demographics
NPI:1891817318
Name:EARL, J. LAWRENCE (DMD)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:LAWRENCE
Last Name:EARL
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 1:5280 S EASTERN AVE STE C1
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-2397
Mailing Address - Country:US
Mailing Address - Phone:702-798-7724
Mailing Address - Fax:702-798-9770
Practice Address - Street 1:5280 S EASTERN AVE STE C1
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-2397
Practice Address - Country:US
Practice Address - Phone:702-798-7724
Practice Address - Fax:702-798-9770
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice