Provider Demographics
NPI:1174687149
Name:SHANARD, LAUREN JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:JEAN
Last Name:SHANARD
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 1:54 HENDERSON TER
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3514
Mailing Address - Country:US
Mailing Address - Phone:802-660-2933
Mailing Address - Fax:
Practice Address - Street 1:75 TALCOTT RD STE 60
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-8122
Practice Address - Country:US
Practice Address - Phone:802-878-9888
Practice Address - Fax:802-878-8383
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00011081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1002868Medicaid