Provider Demographics
NPI:1194219246
Name:RENAUD, LAUREN KAYLA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:KAYLA
Last Name:RENAUD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2441 STATE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4962
Mailing Address - Country:US
Mailing Address - Phone:812-944-8200
Mailing Address - Fax:
Practice Address - Street 1:2441 STATE ST STE 1
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4962
Practice Address - Country:US
Practice Address - Phone:812-944-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10155122300000X
IN12013893A1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist