Provider Demographics
NPI:1588153472
Name:LAWRENCE DENTAL STUDIO
Entity type:Organization
Organization Name:LAWRENCE DENTAL STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAVA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:785-727-8128
Mailing Address - Street 1:5100 BOB BILLINGS PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4094
Mailing Address - Country:US
Mailing Address - Phone:785-749-2943
Mailing Address - Fax:785-749-0929
Practice Address - Street 1:5100 BOB BILLINGS PKWY STE 110
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-4094
Practice Address - Country:US
Practice Address - Phone:785-749-2943
Practice Address - Fax:785-749-0929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-06
Last Update Date:2018-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS613071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty