Provider Demographics
NPI:1255525796
Name:FATICA, LAWRENCE JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOHN
Last Name:FATICA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 ZUCK RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-3174
Mailing Address - Country:US
Mailing Address - Phone:814-833-3535
Mailing Address - Fax:814-833-3492
Practice Address - Street 1:2702 ZUCK RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-3174
Practice Address - Country:US
Practice Address - Phone:814-833-3535
Practice Address - Fax:814-833-3492
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADL016908122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist