Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 19251 | OH |
NPI | 1013031814 |
---|---|
Provider Name | Lawrence C. Chen |
First Address | Warren, OH 44484-3869 |
Second Address | Warren, OH 44484-3869 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |