Healthcare Provider Details

I. General information

NPI: 1700882974
Provider Name (Legal Business Name): LAWRENCE FRANKLIN PERKINS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

837 S FAIR OAKS AVE STE 203
PASADENA CA
91105-2646
US

IV. Provider business mailing address

837 S FAIR OAKS AVE STE 203
PASADENA CA
91105-2646
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-2107
  • Fax: 626-795-7107
Mailing address:
  • Phone: 626-793-2107
  • Fax: 626-795-7107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: