Basic Information
| Provider Information | |||||||||
| NPI: | 1265577704 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MESICH | ||||||||
| FirstName: | LAWRENCE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11263 | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374012263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237783274 | ||||||||
| FaxNumber: | 4237782255 | ||||||||
| Practice Location | |||||||||
| Address1: | 730 E 11TH ST | ||||||||
| Address2: | |||||||||
| City: | CHATTANOOGA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 374033103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232655708 | ||||||||
| FaxNumber: | 4232655713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 09/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 3963 | TN | Y | Dental Providers | Dentist |
No ID Information.