MEDICARE: DR. JU U LAWRENCE DMD

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	1223G0001X	General Practice Dentistry	D5255	AZ
2	1223G0001X	General Practice Dentistry	7277	OR
3	1223P0221X	Pediatric Dentistry	57203	CA

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	:	1356302608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JU U LAWRENCE DMD

Provider Business Mailing Address
First Line	:	9201 N 5TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2532
Country	:	US
Telephone Number	:	623-434-3943
Fax Number	:	623-321-6268

Provider Business Practice Location Address
First Line	:	717 WALNUT DR
Second Line	:
City	:	PASO ROBLES
State	:	CA
Zip	:	93446-2315
Country	:	US
Telephone Number	:	805-238-5334
Fax Number	:

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

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	10/05/2017

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