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General NPI Number Information
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NPI Number | 1427598507
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Entity Type | Organization
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Legal Business Name | STEPHEN M. LAWRENCE ,DMD, P.C.
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 03/08/2017
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Provider Practice Location Address
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Address Line | 1500 WYOMING AVE
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City | FORTY FORT
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State | PA
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Zip | 18704-4219
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Country | US
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Telephone | 570-288-5588
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Fax | 570-288-4345
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Provider Business Mailing Address
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Address Line | 1500 WYOMING AVE
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City | FORTY FORT
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State | PA
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Zip | 18704-4219
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Country | US
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Telephone | 570-288-5588
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Fax | 570-288-4345
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Authorized Official
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Title or Position | OWNER/ DENTIST
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Name | DR. STEPHEN MARK LAWRENCE
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Credential | DMD
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Telephone | 570-288-5588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 21791
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License Number State | PA
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