Provider Demographics
NPI:1780744201
Name:CHACKER, LAURENCE G (DMD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:G
Last Name:CHACKER
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 1:6 COLONIAL LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4126
Mailing Address - Country:US
Mailing Address - Phone:609-883-6900
Mailing Address - Fax:609-883-2785
Practice Address - Street 1:6 COLONIAL LAKE DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4126
Practice Address - Country:US
Practice Address - Phone:609-883-6900
Practice Address - Fax:609-883-2785
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ01161701223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics