Provider Demographics
NPI:1952505562
Name:LAWRENCE DENTAL SERVICES LLC
Entity Type:Organization
Organization Name:LAWRENCE DENTAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-636-6220
Mailing Address - Street 1:915 SOUTHWEST BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-5014
Mailing Address - Country:US
Mailing Address - Phone:573-636-6220
Mailing Address - Fax:573-636-2155
Practice Address - Street 1:915 SOUTHWEST BLVD STE D
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65109-5014
Practice Address - Country:US
Practice Address - Phone:573-636-6220
Practice Address - Fax:573-636-2155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE014989261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental