Provider Demographics
NPI:1225522972
Name:KERSJES, LAUREN (DMD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:KERSJES
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 1:1243 E BROWNING AVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-2525
Mailing Address - Country:US
Mailing Address - Phone:616-558-6814
Mailing Address - Fax:
Practice Address - Street 1:8706 S 700 E STE 100
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-1808
Practice Address - Country:US
Practice Address - Phone:801-255-3351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-17
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61021787122300000X
IL019031579122300000X
UT13636315-9926122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist