Healthcare Provider Details

I. General information

NPI: 1871638809
Provider Name (Legal Business Name): LAWRENCE WALTON WILL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255522 MARGUERITE PARKWAY
MISSION VIEJO CA
92692
US

IV. Provider business mailing address

29771 RUNNING DEER LN
LAGUNA NIGUEL CA
92677-2026
US

V. Phone/Fax

Practice location:
  • Phone: 949-586-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number21292
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: