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General NPI Number Information
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NPI Number | 1821447624
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Entity Type | Individual
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Provider Name | JASON LAWRENCE D.D.S., M.S.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2016
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 5655 HUDSON DR STE 310
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City | HUDSON
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State | OH
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Zip | 44236-4454
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Country | US
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Telephone | 330-342-0930
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Fax |
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Provider Business Mailing Address
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Address Line | 63 WHARF ST SUITE 100
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City | MORGANTOWN
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State | WV
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Zip | 26501-5937
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Country | US
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Telephone | 304-542-2710
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Fax |
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 4062
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 30.025268
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License Number State | OH
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