MEDICARE: TIMOTHY M. LAWRENCE, DDS, MS, INC.

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)	3016301	OH

General Provider Information

NPI Number	:	1528338704
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY M. LAWRENCE, DDS, MS, INC.

Provider Business Mailing Address
First Line	:	4333 MONROE ST STE A
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-1937
Country	:	US
Telephone Number	:	419-473-2707
Fax Number	:	419-473-0142

Provider Business Practice Location Address
First Line	:	4333 MONROE ST STE A
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-1937
Country	:	US
Telephone Number	:	419-473-2707
Fax Number	:	419-473-0142

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TIMOTHY M. LAWRENCE
Credential	:	DDS, MS
Telephone Number	:	419-473-2707

Provider Enumeration Date	:	01/05/2012
Last Update Date	:	01/05/2012

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