Provider Demographics
NPI:1649534116
Name:LAWLER, MATTHEW E (DMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:E
Last Name:LAWLER
Suffix:
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 1:20 LONG CREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-772-4063
Mailing Address - Fax:207-772-8641
Practice Address - Street 1:20 LONG CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-772-4063
Practice Address - Fax:207-772-8641
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME4595204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery