Provider Demographics
NPI:1770621120
Name:ALBERT, LAWRENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:ALBERT
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 1:215 SUFFIELD VLG
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-2122
Mailing Address - Country:US
Mailing Address - Phone:860-668-4431
Mailing Address - Fax:860-668-6721
Practice Address - Street 1:215 SUFFIELD VLG
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-2122
Practice Address - Country:US
Practice Address - Phone:860-668-4431
Practice Address - Fax:860-668-6721
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT41371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice