Healthcare Provider Details

I. General information

NPI: 1255487658
Provider Name (Legal Business Name): VICTOR A LAWRENCE DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6822 LOOP ROAD
DAYTON OH
45459-2159
US

IV. Provider business mailing address

5462 FOLKESTONE DRIVE
DAYTON OH
45459
US

V. Phone/Fax

Practice location:
  • Phone: 937-434-2344
  • Fax: 937-435-8317
Mailing address:
  • Phone: 937-434-2344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number11037
License Number StateOH

VIII. Authorized Official

Name: DR. VICTOR A LAWRENCE JR.
Title or Position: PRESIDENT
Credential: DDS
Phone: 937-435-8202