Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0300X | Periodontist | 034649 | NY |
Y | 1223P0300X | Periodontist | DN23290 | FL |
NPI | 1013134915 |
---|---|
Provider Name | Dr. Lawrence S Tesser |
First Address | Orlando, FL 32836-5059 |
Second Address | Tampa, FL 33629-5692 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2007 |
Last Update Date | 07/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DN23290 | DENTIST (01) | FL |