1992861025 NPI number — DR. LAWRENCE ANDREW BOYLE DDS

Table of content: DR. LAWRENCE ANDREW BOYLE DDS (NPI 1992861025)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992861025 NPI number — DR. LAWRENCE ANDREW BOYLE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOYLE
Provider First Name:
LAWRENCE
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
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:
1992861025
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:
PO BOX 535
Provider Second Line Business Mailing Address:
1332 POST ROAD UNIT 1A
Provider Business Mailing Address City Name:
WELLS
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04090-0535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-646-5297
Provider Business Mailing Address Fax Number:
207-646-1296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1332 POST RD
Provider Second Line Business Practice Location Address:
UNIT 1A
Provider Business Practice Location Address City Name:
WELLS
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04090-4561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-646-5297
Provider Business Practice Location Address Fax Number:
207-646-1296
Provider Enumeration Date:
01/01/2007

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:  5294 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5294 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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