Provider Demographics
NPI:1871995647
Name:STEPHEN A. LAWRENCE, DDS, INC.
Entity type:Organization
Organization Name:STEPHEN A. LAWRENCE, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-729-9050
Mailing Address - Street 1:785 GRAND AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2370
Mailing Address - Country:US
Mailing Address - Phone:760-729-9050
Mailing Address - Fax:760-729-3572
Practice Address - Street 1:785 GRAND AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2370
Practice Address - Country:US
Practice Address - Phone:760-729-9050
Practice Address - Fax:760-729-3572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34865261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental