Provider Demographics
NPI:1265441232
Name:RIVERS, LAWRENCE DURRELL (DDS PA)
Entity type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:DURRELL
Last Name:RIVERS
Suffix:
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 PLEASANT PINES DRIVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1915
Mailing Address - Country:US
Mailing Address - Phone:919-787-7373
Mailing Address - Fax:919-787-0890
Practice Address - Street 1:6320 PLEASANT PINES DRIVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-1915
Practice Address - Country:US
Practice Address - Phone:919-787-7373
Practice Address - Fax:919-787-0890
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3119122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8997410Medicaid