Healthcare Provider Details

I. General information

NPI: 1447360805
Provider Name (Legal Business Name): DENTISTS IN LAWRENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 VERMONT ST
LAWRENCE KS
66044-2665
US

IV. Provider business mailing address

831 VERMONT ST
LAWRENCE KS
66044-2665
US

V. Phone/Fax

Practice location:
  • Phone: 785-843-6060
  • Fax: 785-843-4335
Mailing address:
  • Phone: 785-843-6060
  • Fax: 785-843-4335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. JUSTIN R ANDERSON
Title or Position: OWNER
Credential: DDS
Phone: 785-843-6060