Healthcare Provider Details

I. General information

NPI: 1376557934
Provider Name (Legal Business Name): LAWRENCE A PAULEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 S RANGE LINE RD
CARMEL IN
46032-2188
US

IV. Provider business mailing address

624 S RANGE LINE RD
CARMEL IN
46032-2188
US

V. Phone/Fax

Practice location:
  • Phone: 317-848-1810
  • Fax: 317-815-4660
Mailing address:
  • Phone: 317-848-1810
  • Fax: 317-815-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10369
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: