Individual provider Active NPI

Lawrence Willard Life, D.M.D.

  • General Practice Dentistry
  • East Longmeadow, MA
National Provider Identifier
1700824190
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
14837 Issued in MA
Practice address
200 N Main St
Suite 1104
East Longmeadow, MA 01028-2392
Phone
(413) 525-6123
Fax
(413) 525-8999
NPI assigned
Jun 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 14837 MA Primary

Addresses

Primary practice location

200 N Main St
Suite 1104
East Longmeadow, MA 01028-2392

Mailing address

200 N Main St
Suite 1104
East Longmeadow, MA 01028-2392
Phone (413) 525-6123

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151123002286 MA Order and Referring Only - DentistPractitioner - Dentist 7618277690

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
14837MAMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1700824190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 N MAIN ST",
            "address_2": "SUITE 1104",
            "city": "EAST LONGMEADOW",
            "state": "MA",
            "postal_code": "010282392",
            "telephone_number": "413-525-6123",
            "fax_number": "413-525-8999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N MAIN ST",
            "address_2": "SUITE 1104",
            "city": "EAST LONGMEADOW",
            "state": "MA",
            "postal_code": "010282392",
            "telephone_number": "413-525-6123",
            "fax_number": "413-525-8999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIFE",
        "first_name": "LAWRENCE",
        "middle_name": "WILLARD",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-04",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "14837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in East Longmeadow, MA

Sources for this page

Verify at the official NPI Registry.