Provider Demographics
NPI:1932463361
Name:LAWRENCE, REGAN B (DDS)
Entity Type:Individual
Prefix:
First Name:REGAN
Middle Name:B
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22770 SOLEDAD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:CA
Mailing Address - Zip Code:91350-2629
Mailing Address - Country:US
Mailing Address - Phone:661-259-9674
Mailing Address - Fax:
Practice Address - Street 1:22770 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:CA
Practice Address - Zip Code:91350-2629
Practice Address - Country:US
Practice Address - Phone:661-259-9674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47391122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist