Healthcare Provider Details

I. General information

NPI: 1255492617
Provider Name (Legal Business Name): LAWRENCE ALAN SAUNDERS DMD,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 GEORGIA LN
PORTOLA VALLEY CA
94028-7929
US

IV. Provider business mailing address

165 GEORGIA LN
PORTOLA VALLEY CA
94028-7929
US

V. Phone/Fax

Practice location:
  • Phone: 650-544-5297
  • Fax: 650-851-9893
Mailing address:
  • Phone: 650-544-5297
  • Fax: 650-851-9893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number20264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: