Provider Demographics
NPI:1316959547
Name:LAWRENCE B. EVANS, DDS, MS, PC
Entity type:Organization
Organization Name:LAWRENCE B. EVANS, DDS, MS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:770-962-9560
Mailing Address - Street 1:55 TOWLER RD
Mailing Address - Street 2:BUILDING B
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-4717
Mailing Address - Country:US
Mailing Address - Phone:770-962-9560
Mailing Address - Fax:770-822-4529
Practice Address - Street 1:55 TOWLER RD
Practice Address - Street 2:BUILDING B
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-4717
Practice Address - Country:US
Practice Address - Phone:770-962-9560
Practice Address - Fax:770-822-4529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA97891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty