Provider Demographics
NPI:1255337564
Name:KENT, LAWRENCE H (DDS)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:H
Last Name:KENT
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 1:1912 LEXINGTON AVE N STE 150
Mailing Address - Street 2:700 VILLAGE CENTER DRIVE, #170, NORTH OAKS, MN 55127
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-6100
Mailing Address - Country:US
Mailing Address - Phone:651-636-2420
Mailing Address - Fax:651-636-3199
Practice Address - Street 1:1912 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-6113
Practice Address - Country:US
Practice Address - Phone:651-636-2420
Practice Address - Fax:651-482-6144
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41971223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33703200Medicaid
WI33703200Medicaid