MEDICARE: LAWRENCE D DUFFIELD DDS PC

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	2901013218	MI

General Provider Information

NPI Number	:	1447647185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE D DUFFIELD DDS PC

Provider Business Mailing Address
First Line	:	2009 CROOKS RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-4049
Country	:	US
Telephone Number	:	248-541-1388
Fax Number	:	248-541-2672

Provider Business Practice Location Address
First Line	:	2009 CROOKS RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-4049
Country	:	US
Telephone Number	:	248-541-1388
Fax Number	:	248-541-2672

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LAWRENCE DAVID DUFFIELD
Credential	:	DDS
Telephone Number	:	248-541-1388

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	04/21/2015

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