Provider Demographics
NPI:1336527340
Name:ROSSOFF, LAWRENCE
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:ROSSOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 SHAKER BLVD
Mailing Address - Street 2:#136
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44104-3869
Mailing Address - Country:US
Mailing Address - Phone:216-368-7238
Mailing Address - Fax:216-791-8322
Practice Address - Street 1:11201 SHAKER BLVD
Practice Address - Street 2:#136
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44104-3869
Practice Address - Country:US
Practice Address - Phone:216-368-7238
Practice Address - Fax:216-791-8322
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-023665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist