Healthcare Provider Details

I. General information

NPI: 1255337564
Provider Name (Legal Business Name): LAWRENCE H KENT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 LEXINGTON AVE N
ROSEVILLE MN
55113-6113
US

IV. Provider business mailing address

1912 LEXINGTON AVE N STE 150 700 VILLAGE CENTER DRIVE, #170, NORTH OAKS, MN 55127
ROSEVILLE MN
55113-6100
US

V. Phone/Fax

Practice location:
  • Phone: 651-636-2420
  • Fax: 651-482-6144
Mailing address:
  • Phone: 651-636-2420
  • Fax: 651-636-3199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4197
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: