Provider Demographics
NPI:1922117431
Name:MAHER, LAWRENCE WARREN III (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:WARREN
Last Name:MAHER
Suffix:III
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 1:505 W FAIRMONT PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-6312
Mailing Address - Country:US
Mailing Address - Phone:281-471-1797
Mailing Address - Fax:281-471-6339
Practice Address - Street 1:505 W FAIRMONT PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-6312
Practice Address - Country:US
Practice Address - Phone:281-471-1797
Practice Address - Fax:281-471-6339
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice