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General NPI Number Information
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NPI Number | 1245440148
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Entity Type | Individual
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Provider Name | LAWRENCE P EVOLA D.D.S
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 11/03/2023
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Provider Practice Location Address
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Address Line | 101 HARTH PL
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8107
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Country | US
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Telephone | 843-875-5111
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Fax |
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Provider Business Mailing Address
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Address Line | 1533 EASTHAM LN STE 4
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City | MT PLEASANT
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State | SC
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Zip | 29466-7563
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Country | US
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Telephone | 171-687-0648
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Fax | 716-656-8713
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9663
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License Number State | SC
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