Healthcare Provider Details

I. General information

NPI: 1629163050
Provider Name (Legal Business Name): LAURA D LAWSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 TELEGRAPH AVE 300
BERKELEY CA
94705
US

IV. Provider business mailing address

3017 TELEGRAPH AVE 300
BERKELEY CA
94705-3629
US

V. Phone/Fax

Practice location:
  • Phone: 510-549-2848
  • Fax: 510-849-1511
Mailing address:
  • Phone: 510-549-2848
  • Fax: 510-849-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number50302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: