Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 018.001932 | IL |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 2901022843 | MI |
NPI | 1134525967 |
---|---|
Provider Name | Adam Lawrence |
First Address | Midland, MI 48640-7358 |
Second Address | Midland, MI 48640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2014 |
Last Update Date | 17/02/2020 |