Provider Demographics
NPI:1447306386
Name:DUFFY, LAWRENCE (DMD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:DUFFY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 E ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-6047
Mailing Address - Country:US
Mailing Address - Phone:407-894-4921
Mailing Address - Fax:407-894-4870
Practice Address - Street 1:2122 E ROBINSON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-6047
Practice Address - Country:US
Practice Address - Phone:407-894-4921
Practice Address - Fax:407-894-4870
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN104801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice