Provider Demographics
NPI:1982566824
Name:LAWRENCE, REBECCA LYNNE (DMD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:LYNNE
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S SPRING ST APT 3
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1989
Mailing Address - Country:US
Mailing Address - Phone:262-891-2710
Mailing Address - Fax:
Practice Address - Street 1:2323 LIME KILN LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3416
Practice Address - Country:US
Practice Address - Phone:502-423-0781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYD-00103122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist