MEDICARE: DR. TIMOTHY MELVIN LAWRENCE D.D.S., M.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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	16301	OH
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	2901012686	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386700953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY MELVIN LAWRENCE D.D.S., M.S.

Provider Business Mailing Address
First Line	:	4333 MONROE ST
Second Line	:	SUITE A
City	:	TOLEDO
State	:	OH
Zip	:	43606-1981
Country	:	US
Telephone Number	:	419-473-2707
Fax Number	:	419-473-0142

Provider Business Practice Location Address
First Line	:	4333 MONROE ST
Second Line	:	SUITE A
City	:	TOLEDO
State	:	OH
Zip	:	43606-1981
Country	:	US
Telephone Number	:	419-473-2707
Fax Number	:	419-473-0142

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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