Provider Demographics
NPI:1992874044
Name:MULVANEY, LAWRENCE A (DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:A
Last Name:MULVANEY
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 1:400 LAKE COOK RD STE 115
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4929
Mailing Address - Country:US
Mailing Address - Phone:847-945-3515
Mailing Address - Fax:
Practice Address - Street 1:7745 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4735
Practice Address - Country:US
Practice Address - Phone:847-967-6744
Practice Address - Fax:847-967-1460
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190206001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice