Individual
DR. ROGER BRENT LAWRENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5415 SW WESTGATE DR, SUITE 206, PORTLAND, OR 97221-2409
(503) 292-1173
(503) 291-0353
Mailing address
5415 SW WESTGATE DR, SUITE 206, PORTLAND, OR 97221-2409
(503) 292-1173
(503) 291-0353
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D6374
OR
Other
Enumeration date
04/18/2006
Last updated
07/08/2007
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