Provider Demographics
NPI:1306849963
Name:GETTLEMAN, LAWRENCE (DMD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:GETTLEMAN
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 1:1461 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-2118
Mailing Address - Country:US
Mailing Address - Phone:502-634-1461
Mailing Address - Fax:502-634-1461
Practice Address - Street 1:SCHOOL OF DENTISTRY, FACULTY PRACTICE PLAN
Practice Address - Street 2:501 S. PRESTON ST, UNIVERSITY OF LOUISVILLE
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40292-0001
Practice Address - Country:US
Practice Address - Phone:502-852-5401
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY64241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60064243Medicaid