Provider Demographics
NPI:1992730006
Name:O'HALLORAN, LAWRENCE WILLIAM (DDS)
Entity type:Individual
Prefix:MISS
First Name:LAWRENCE
Middle Name:WILLIAM
Last Name:O'HALLORAN
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 1:3645 RHODE ISLAND AVE S
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-4030
Mailing Address - Country:US
Mailing Address - Phone:952-938-7628
Mailing Address - Fax:
Practice Address - Street 1:3645 RHODE ISLAND AVE S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4030
Practice Address - Country:US
Practice Address - Phone:952-938-7628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND75851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice