Provider Demographics
NPI:1134789704
Name:LAWRENCE, LAURA (DMD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:GERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:3690 ORANGE PL STE 180
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4438
Mailing Address - Country:US
Mailing Address - Phone:440-230-6124
Mailing Address - Fax:
Practice Address - Street 1:3690 ORANGE PL STE 180
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4438
Practice Address - Country:US
Practice Address - Phone:440-230-6124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026241122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134789704OtherNPI