MEDICARE: DR. LAWRENCE ERIC SUAZO D.D.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	1223P0221X	Pediatric Dentistry	DD1997	NM

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	:	1760443998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE ERIC SUAZO D.D.S.

Provider Business Mailing Address
First Line	:	2650 E. PINON FRONTAGE RD. BLDG. 200
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87402-5061
Country	:	US
Telephone Number	:	505-599-9359
Fax Number	:	505-599-8177

Provider Business Practice Location Address
First Line	:	2650 E. PINON FRONTAGE RD. BLDG. 200
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87402-5061
Country	:	US
Telephone Number	:	505-599-9359
Fax Number	:	505-599-8177

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	11/25/2014

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Directions to “ DR. LAWRENCE ERIC SUAZO D.D.S.” Practice Location

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