Healthcare Provider Details

I. General information

NPI: 1184874075
Provider Name (Legal Business Name): LAWSON FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MARKET ST
PETERSTOWN WV
24963
US

IV. Provider business mailing address

102 MARKET ST
PETERSTOWN WV
24963
US

V. Phone/Fax

Practice location:
  • Phone: 304-753-5400
  • Fax: 304-753-4349
Mailing address:
  • Phone: 304-753-5400
  • Fax: 304-753-4349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2487
License Number StateWV

VIII. Authorized Official

Name: DR. GARY RONALD LAWSON
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 304-327-8177