Healthcare Provider Details

I. General information

NPI: 1629981428
Provider Name (Legal Business Name): GABRIELLE ANN LAWRENCE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 N STONE RD STE 102
FREMONT MI
49412-8629
US

IV. Provider business mailing address

4560 FRASER RD
BAY CITY MI
48706-9423
US

V. Phone/Fax

Practice location:
  • Phone: 231-924-5542
  • Fax:
Mailing address:
  • Phone: 989-971-3639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901603291
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: