Provider Demographics
NPI:1174699789
Name:LAWRENCE E. PORTEOUS DDS
Entity type:Organization
Organization Name:LAWRENCE E. PORTEOUS DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:PORTEOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-736-9000
Mailing Address - Street 1:3840 BLACKHAWK RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4900
Mailing Address - Country:US
Mailing Address - Phone:925-736-9000
Mailing Address - Fax:925-736-9024
Practice Address - Street 1:3840 BLACKHAWK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4900
Practice Address - Country:US
Practice Address - Phone:925-736-9000
Practice Address - Fax:925-736-9024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty