Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DE |
NPI | 1003089533 |
---|---|
Provider Name | Dr. John S Lawrence |
First Address | Newark, DE 19713 |
Second Address | Newark, DE 19713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2008 |
Last Update Date | 04/04/2008 |