Provider Demographics
NPI:1881731891
Name:LAWRENCE J PIJUT DMD PA
Entity type:Organization
Organization Name:LAWRENCE J PIJUT DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PIJUT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-216-2500
Mailing Address - Street 1:2560 CAPITAL MEDICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4424
Mailing Address - Country:US
Mailing Address - Phone:850-216-2500
Mailing Address - Fax:850-216-2534
Practice Address - Street 1:2560 CAPITAL MEDICAL BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4424
Practice Address - Country:US
Practice Address - Phone:850-216-2500
Practice Address - Fax:850-216-2534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00136811223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty