Provider Demographics
NPI:1538210810
Name:LAWRENCE, BRYCE FARR (DDS)
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:FARR
Last Name:LAWRENCE
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 1:3225 W CAREFREE CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-3004
Mailing Address - Country:US
Mailing Address - Phone:719-597-5737
Mailing Address - Fax:719-597-1838
Practice Address - Street 1:3225 W CAREFREE CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-3004
Practice Address - Country:US
Practice Address - Phone:719-597-5737
Practice Address - Fax:719-597-1838
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO87871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice