Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 6058 | AL |
Y | 1223P0221X | Pediatric Dentist | 8525 | SC |
NPI | 1083054795 |
---|---|
Provider Name | Dr. Lauren Paul Dean |
First Address | Birmingham, AL 35209-4333 |
Second Address | Rock Hill, SC 29732-3390 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2013 |
Last Update Date | 10/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ZX8525 | (05) | SC |