Healthcare Provider Details

I. General information

NPI: 1568465086
Provider Name (Legal Business Name): JOHN P. LAWLOR, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2005
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 8TH ST
PRINCETON IN
47670-1109
US

IV. Provider business mailing address

PO BOX 1179
PRINCETON IN
47670-0879
US

V. Phone/Fax

Practice location:
  • Phone: 812-385-2990
  • Fax:
Mailing address:
  • Phone: 812-385-2990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number54000883A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number54000883A
License Number StateIN

VIII. Authorized Official

Name: DR. JOHN PATRICK LAWLOR
Title or Position: PRESIDENT
Credential: DDS
Phone: 812-385-2990