Provider Demographics
NPI:1396969911
Name:STAFF, LAWRENCE GEORGE III (DMD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:GEORGE
Last Name:STAFF
Suffix:III
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 1:2260 WEST BAY DRIVE
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770
Mailing Address - Country:US
Mailing Address - Phone:727-584-8639
Mailing Address - Fax:727-584-8519
Practice Address - Street 1:2260 WEST BAY DRIVE
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770
Practice Address - Country:US
Practice Address - Phone:727-584-8639
Practice Address - Fax:727-584-8519
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15746122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist