MEDICARE: DR. LAWRENCE DAVID DUFFIELD DDS

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	122300000X	Dentist	013218	MI

General Provider Information

NPI Number	:	1326038266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE DAVID DUFFIELD DDS

Provider Business Mailing Address
First Line	:	2009 CROOKS RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-4049
Country	:	US
Telephone Number	:	248-541-1388
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 CROOKS RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-4049
Country	:	US
Telephone Number	:	248-541-1388
Fax Number	:

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	09/04/2007

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