Provider Demographics
NPI:1235506593
Name:MARTIN, LAUREN PHILLIPS (DDS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:PHILLIPS
Last Name:MARTIN
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 1:3705 SYMI CIR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4314
Mailing Address - Country:US
Mailing Address - Phone:252-247-3510
Mailing Address - Fax:252-247-6197
Practice Address - Street 1:3705 SYMI CIR
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4314
Practice Address - Country:US
Practice Address - Phone:252-247-3510
Practice Address - Fax:252-247-6197
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10190122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist