Provider Demographics
NPI:1992861025
Name:BOYLE, LAWRENCE ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:ANDREW
Last Name:BOYLE
Suffix:
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:PO BOX 535
Mailing Address - Street 2:1332 POST ROAD UNIT 1A
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-0535
Mailing Address - Country:US
Mailing Address - Phone:207-646-5297
Mailing Address - Fax:207-646-1296
Practice Address - Street 1:1332 POST RD
Practice Address - Street 2:UNIT 1A
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090-4561
Practice Address - Country:US
Practice Address - Phone:207-646-5297
Practice Address - Fax:207-646-1296
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME52941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME5294OtherSTATE LICENSE NUMBER