MEDICARE: DR. STEPHEN MARK LAWRENCE D.M.D

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	1223G0001X	General Practice Dentistry	021791-L	PA

General Provider Information

NPI Number	:	1841334869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN MARK LAWRENCE D.M.D

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	:	507-288-4345

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	:	507-288-4345

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	07/08/2007

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