Provider Demographics
NPI:1386854990
Name:LAWSON, LARRY DANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:DANIEL
Last Name:LAWSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 905
Mailing Address - Street 2:308 WASHINGTON ST.
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-0905
Mailing Address - Country:US
Mailing Address - Phone:864-366-5511
Mailing Address - Fax:864-366-2232
Practice Address - Street 1:308 WASHINGTON ST
Practice Address - Street 2:308 WASHINGTON ST.
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-1833
Practice Address - Country:US
Practice Address - Phone:864-366-5511
Practice Address - Fax:864-366-2232
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC 15961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice