MEDICARE: STEPHEN M. LAWRENCE ,DMD, P.C.

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	21791	PA

General Provider Information

NPI Number	:	1427598507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN M. LAWRENCE ,DMD, P.C.

Provider Business Mailing Address
First Line	:	1500 WYOMING AVE
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4219
Country	:	US
Telephone Number	:	570-288-5588
Fax Number	:	570-288-4345

Provider Business Practice Location Address
First Line	:	1500 WYOMING AVE
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4219
Country	:	US
Telephone Number	:	570-288-5588
Fax Number	:	570-288-4345

Authorized Official
Title or Position	:	OWNER/ DENTIST
Name	:	DR. STEPHEN MARK LAWRENCE
Credential	:	DMD
Telephone Number	:	570-288-5588

Provider Enumeration Date	:	03/08/2017
Last Update Date	:	03/08/2017

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