| J. Richard Lawrence | |
|
206 Clay Pitts Rd East Northport NY 11731-3423 | |
| (631) 266-5061 | |
| (631) 266-5065 |
| Full Name | J. Richard Lawrence |
|---|---|
| Speciality | Dentist |
| Location | 206 Clay Pitts Rd, East Northport, New York |
| Authorized Official Name and Position | Joseph Richard Lawrence (DENTIST OWNER) |
| Authorized Official Contact | 6312665061 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| J. Richard Lawrence 206 Clay Pitts Road East Northport NY 11731-3421 Ph: (631) 266-5061 | J. Richard Lawrence 206 Clay Pitts Rd East Northport NY 11731-3423 Ph: (631) 266-5061 |
| NPI Number | 1467760678 |
|---|---|
| Provider Enumeration Date | 09/22/2010 |
| Last Update Date | 09/22/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467760678 | NPI | - | NPPES |
| 01200146 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 36108 (New York) | Primary |
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