MEDICARE: DR. LAWRENCE M WILLIS JR. DDS

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	104956	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265650246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE M WILLIS JR. DDS

Provider Business Mailing Address
First Line	:	6537 E 72ND PL
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-1704
Country	:	US
Telephone Number	:	303-288-7020
Fax Number	:

Provider Business Practice Location Address
First Line	:	6537 E 72ND PL
Second Line	:
City	:	COMMERCE CITY
State	:	CO
Zip	:	80022-1704
Country	:	US
Telephone Number	:	303-288-7020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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