MEDICARE: TED LAWSON DDS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	19199	TX

General Provider Information

NPI Number	:	1043540677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TED LAWSON DDS PLLC

Provider Business Mailing Address
First Line	:	2012 LAKE AIR DR STE A
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-7902
Country	:	US
Telephone Number	:	254-751-7100
Fax Number	:	254-751-7144

Provider Business Practice Location Address
First Line	:	2012 LAKE AIR DR STE A
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-7902
Country	:	US
Telephone Number	:	254-751-7100
Fax Number	:	254-751-7144

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. TED LAWSON
Credential	:	D.D.S.
Telephone Number	:	254-751-7100

Provider Enumeration Date	:	01/04/2010
Last Update Date	:	01/04/2010

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