Provider Demographics
NPI:1386700953
Name:LAWRENCE, TIMOTHY MELVIN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MELVIN
Last Name:LAWRENCE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 MONROE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1981
Mailing Address - Country:US
Mailing Address - Phone:419-473-2707
Mailing Address - Fax:419-473-0142
Practice Address - Street 1:4333 MONROE ST
Practice Address - Street 2:SUITE A
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1981
Practice Address - Country:US
Practice Address - Phone:419-473-2707
Practice Address - Fax:419-473-0142
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH163011223S0112X
MI29010126861223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0699874Medicaid
OHT48021Medicare UPIN
OHLA0545701Medicare ID - Type Unspecified