Provider Demographics
NPI:1396752010
Name:LAWS, JERRY A (DDS)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:A
Last Name:LAWS
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 1653
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27293
Mailing Address - Country:US
Mailing Address - Phone:336-249-7708
Mailing Address - Fax:336-249-6490
Practice Address - Street 1:803 EAST CENTER STREET
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292
Practice Address - Country:US
Practice Address - Phone:336-249-7708
Practice Address - Fax:336-249-6490
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC4292122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8995153Medicaid
403559OtherUNITED CONCORDIA
NC95153OtherBLUE CROSS
U37313Medicare UPIN