MEDICARE: JOHN P. LAWLOR, DDS, PC

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	261QD0000X	Dental Clinic/Center	54000883A	IN
2	1223G0001X	General Practice Dentistry	54000883A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000591046	OTHER	UNITED CONCORDIA INS.
2	02025	OTHER	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568465086
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN P. LAWLOR, DDS, PC

Provider Business Mailing Address
First Line	:	PO BOX 1179
Second Line	:
City	:	PRINCETON
State	:	IN
Zip	:	47670-0879
Country	:	US
Telephone Number	:	812-385-2990
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 8TH ST
Second Line	:
City	:	PRINCETON
State	:	IN
Zip	:	47670-1109
Country	:	US
Telephone Number	:	812-385-2990
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN PATRICK LAWLOR
Credential	:	DDS
Telephone Number	:	812-385-2990

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	02/09/2015

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