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General NPI Number Information
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NPI Number | 1689368698
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Entity Type | Organization
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Legal Business Name | LAWLER FAMILY DENTISTRY HAYWARD
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Dates
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Enumeration Date | 06/05/2023
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 10541 N RANCH RD
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City | HAYWARD
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State | WI
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Zip | 54843-6462
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Country | US
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Telephone | 715-634-2011
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 520
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City | LAKE NEBAGAMON
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State | WI
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Zip | 54849-0520
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Country | US
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Telephone | 715-374-2856
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Fax | 715-374-2299
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Authorized Official
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Title or Position | FRONT OFFICE MANAGER
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Name | SUEANE CHRISTINE NOVACK
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Credential |
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Telephone | 715-374-2856
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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 |
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License Number State |
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