Provider Demographics
NPI:1922296839
Name:CALLEY, LAWRENCE EDWIN (DDS, MS, PC)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:EDWIN
Last Name:CALLEY
Suffix:
Gender:M
Credentials:DDS, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:352 12TH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PLAINWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49080
Mailing Address - Country:US
Mailing Address - Phone:269-685-5761
Mailing Address - Fax:269-685-8985
Practice Address - Street 1:352 12TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PLAINWELL
Practice Address - State:MI
Practice Address - Zip Code:49080
Practice Address - Country:US
Practice Address - Phone:269-685-5761
Practice Address - Fax:269-685-8985
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010115371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics