Provider Demographics
NPI:1093309478
Name:WIDMER, LAUREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:WIDMER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 OAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-8658
Mailing Address - Country:US
Mailing Address - Phone:301-481-6726
Mailing Address - Fax:
Practice Address - Street 1:2236 LOGAN BLVD N STE 502
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-1490
Practice Address - Country:US
Practice Address - Phone:239-262-2677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN211391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics