Healthcare Provider Details

I. General information

NPI: 1659538155
Provider Name (Legal Business Name): DRS. LAWRENCE & ROTTMAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 MONROE ST SUITE A
TOLEDO OH
43606-1981
US

IV. Provider business mailing address

4333 MONROE ST SUITE A
TOLEDO OH
43606-1981
US

V. Phone/Fax

Practice location:
  • Phone: 419-473-2707
  • Fax: 419-473-0142
Mailing address:
  • Phone: 419-473-2707
  • Fax: 419-473-0142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30-16301
License Number StateOH

VIII. Authorized Official

Name: DR. TIMOTHY M. LAWRENCDE
Title or Position: PRESIDENT
Credential: D.D.S., M.S.
Phone: 419-473-2707