Healthcare Provider Details

I. General information

NPI: 1013094929
Provider Name (Legal Business Name): LAWRENCE LIMB D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 BROADWAY SUITE 205
NEW YORK NY
10023-5882
US

IV. Provider business mailing address

20 CUMBERLAND HILL ROAD SUITE #205
WOONSOCKET RI
02895
US

V. Phone/Fax

Practice location:
  • Phone: 212-877-5577
  • Fax:
Mailing address:
  • Phone: 401-766-7980
  • Fax: 401-766-7980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number047550
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: