MEDICARE: DR. BRYAN T LAWRENCE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7063	KY

General Provider Information

NPI Number	:	1164412532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN T LAWRENCE D.D.S.

Provider Business Mailing Address
First Line	:	1220 S 28TH ST
Second Line	:	PARKLAND DENTAL CENTER
City	:	LOUISVILLE
State	:	KY
Zip	:	40211-3402
Country	:	US
Telephone Number	:	502-776-2840
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 S 28TH ST
Second Line	:	PARKLAND DENTAL CENTER
City	:	LOUISVILLE
State	:	KY
Zip	:	40211-3402
Country	:	US
Telephone Number	:	502-776-2840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	04/23/2013

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