1619188158 NPI number — DR. LAWRENCE FALES AYERS III DDS

Table of content: DR. LAWRENCE FALES AYERS III DDS (NPI 1619188158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619188158 NPI number — DR. LAWRENCE FALES AYERS III DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYERS
Provider First Name:
LAWRENCE
Provider Middle Name:
FALES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619188158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6757 LAKE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARRENTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20187-2546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-349-8694
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7120 HERITAGE VILLAGE PLZ
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20155-3067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-754-8809
Provider Business Practice Location Address Fax Number:
703-753-9066
Provider Enumeration Date:
05/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  0401006596 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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