Provider Demographics
NPI:1427161470
Name:LAWRENCE, RAYMOND E (DMD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:E
Last Name:LAWRENCE
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 1:132 NEW BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-1133
Mailing Address - Country:US
Mailing Address - Phone:860-563-3303
Mailing Address - Fax:
Practice Address - Street 1:132 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1133
Practice Address - Country:US
Practice Address - Phone:860-563-3303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT86421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice