Individual
DR. CHARLES J LAURENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
NAVAL MEDICAL CENTER PORTSMOUTH, 620 JOHN PAUL JONES CIR., PORTSMOUTH, VA 23708
(757) 953-8637
Mailing address
1704 HUNGERS PARISH CT, VIRGINIA BEACH, VA 23455-7013
(757) 460-4435
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401006401
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
179332
ANTHEM
—
01
—
794586
TRICARE
—
Enumeration date
03/20/2007
Last updated
12/01/2022
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