Provider Demographics
NPI:1841306909
Name:MARRA, LAWRENCE MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:MATTHEW
Last Name:MARRA
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:3965 HOLCOMB BRIDGE ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092
Mailing Address - Country:US
Mailing Address - Phone:770-448-1188
Mailing Address - Fax:770-448-0179
Practice Address - Street 1:3965 HOLCOMB BRIDGE ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092
Practice Address - Country:US
Practice Address - Phone:770-448-1188
Practice Address - Fax:770-448-0179
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA09517204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
19NCBFLMedicare UPIN
UZ0043Medicare ID - Type Unspecified