Provider Demographics
NPI:1861096810
Name:LAWRENCE, TEMEKIA G (CRDH)
Entity type:Individual
Prefix:MISS
First Name:TEMEKIA
Middle Name:G
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:CRDH
Other - Prefix:
Other - First Name:TEMEKIA
Other - Middle Name:G
Other - Last Name:LAWRENCE-DICKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRDH
Mailing Address - Street 1:1329 MAHAN DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5107
Mailing Address - Country:US
Mailing Address - Phone:850-878-7999
Mailing Address - Fax:
Practice Address - Street 1:1329 MAHAN DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5107
Practice Address - Country:US
Practice Address - Phone:850-878-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23534124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist