Provider Demographics
NPI:1124125281
Name:LAWNICKI, EUGENE WALTER (DMD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:WALTER
Last Name:LAWNICKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2508
Mailing Address - Country:US
Mailing Address - Phone:781-729-1444
Mailing Address - Fax:781-729-1233
Practice Address - Street 1:49 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-2508
Practice Address - Country:US
Practice Address - Phone:781-729-1444
Practice Address - Fax:781-729-1233
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA143571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice