Healthcare Provider Details

I. General information

NPI: 1548257660
Provider Name (Legal Business Name): LAWRENCE R DEHNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 STATE ROAD, NAUSET BLDG
NORTH DARTMOUTH MA
02747-3322
US

IV. Provider business mailing address

200 MILL RD STE 180
FAIRHAVEN MA
02719-5252
US

V. Phone/Fax

Practice location:
  • Phone: 508-973-9240
  • Fax: 508-973-0306
Mailing address:
  • Phone: 508-973-2000
  • Fax: 508-973-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46121
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: