Provider Demographics
NPI:1568495505
Name:RORICK, LAWRENCE RAY (DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:RAY
Last Name:RORICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:LARRY
Other - Middle Name:RAY
Other - Last Name:RORICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4225 OCEANSIDE BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3472
Mailing Address - Country:US
Mailing Address - Phone:760-758-1500
Mailing Address - Fax:760-758-9330
Practice Address - Street 1:4225 OCEANSIDE BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3472
Practice Address - Country:US
Practice Address - Phone:760-758-1500
Practice Address - Fax:760-758-9330
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist