Provider Demographics
NPI:1225265259
Name:MENTASTI, LAUREN (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:MENTASTI
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:MENTASTI
Other - Last Name:CONSONNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD, MPH
Mailing Address - Street 1:32 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3843
Mailing Address - Country:US
Mailing Address - Phone:860-678-1140
Mailing Address - Fax:
Practice Address - Street 1:32 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3843
Practice Address - Country:US
Practice Address - Phone:860-678-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT010045122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist