Provider Demographics
NPI:1285003707
Name:MA, LAUREN JANICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:JANICE
Last Name:MA
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 1:11800 NE 128TH ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7208
Mailing Address - Country:US
Mailing Address - Phone:425-820-0500
Mailing Address - Fax:425-814-2837
Practice Address - Street 1:11800 NE 128TH ST
Practice Address - Street 2:SUITE 520
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7208
Practice Address - Country:US
Practice Address - Phone:425-820-0500
Practice Address - Fax:425-814-2837
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60585171122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist