Mark Jeffrey Lawson, D.M.D.
Individual provider Active NPI General Practice Dentistry · South River, NJ
NPI 1316967482 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1316967482
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 22DI017114000 (NJ)
- Practice address
- 117 Main St
South River, NJ 08882-1231 - Phone
- (732) 254-2347
- Fax
- (732) 257-2638
- NPI assigned
- Jul 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NJ
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150603002728 | NJ | Order and Referring Only - Other (Physician) |
7618298506 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI017114000 | NJ | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 22DI017114000 | NJ | Yes |
Addresses
Primary practice location
117 Main St
South River, NJ 08882-1231
Mailing address
117 Main St
South River, NJ 08882
Phone (732) 254-2347
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4624301 | Medicaid | NJ |
Other providers in South River, NJ
- Maria Koutsoupias
- Cynthia Kozicki
- Sigmund Lewis Kulessa Jr.
- Jean Claude Laborde
- J. Victoria Laszlo
- Charity Mantebea
- Shorok Abdalla Maria
- James Joseph Matera
- Glenda L. Mathew
- Nidhi Mehta
All providers in South River, NJ · General Practice Dentistry in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.