Provider Demographics
NPI:1083271886
Name:LAUREN A. MATHEWS D.DS., INCORPORATED
Entity Type:Organization
Organization Name:LAUREN A. MATHEWS D.DS., INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-412-9291
Mailing Address - Street 1:6230 W MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3801
Mailing Address - Country:US
Mailing Address - Phone:310-412-9291
Mailing Address - Fax:310-649-5854
Practice Address - Street 1:6230 W MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:CA
Practice Address - Zip Code:90045-3801
Practice Address - Country:US
Practice Address - Phone:310-412-9291
Practice Address - Fax:310-649-5854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty