Provider Demographics
NPI:1205212479
Name:MARKS, LAURYN E (DMD)
Entity Type:Individual
Prefix:
First Name:LAURYN
Middle Name:E
Last Name:MARKS
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 1:1401 E 2ND ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3254
Mailing Address - Country:US
Mailing Address - Phone:505-917-2675
Mailing Address - Fax:
Practice Address - Street 1:510 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-3910
Practice Address - Country:US
Practice Address - Phone:503-472-3147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD102971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice