Provider Demographics
NPI:1902203730
Name:LAWRENCE, STEPHEN AARON (DDS, DCH, JCM, THPSY)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:AARON
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:DDS, DCH, JCM, THPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 GRAND AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2370
Mailing Address - Country:US
Mailing Address - Phone:760-729-9050
Mailing Address - Fax:760-729-3572
Practice Address - Street 1:785 GRAND AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2370
Practice Address - Country:US
Practice Address - Phone:760-729-9050
Practice Address - Fax:760-729-3572
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist