Provider Demographics
NPI:1407972029
Name:KAVANAUGH, LAUREN ANN (DENTAL HYGIENE ASSIS)
Entity Type:Individual
Prefix:MISS
First Name:LAUREN
Middle Name:ANN
Last Name:KAVANAUGH
Suffix:
Gender:F
Credentials:DENTAL HYGIENE ASSIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9239 SILVERCREST DR
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126
Mailing Address - Country:US
Mailing Address - Phone:314-843-3420
Mailing Address - Fax:
Practice Address - Street 1:189 BAKER AVE
Practice Address - Street 2:WEBSTER DENTAL CARE
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119
Practice Address - Country:US
Practice Address - Phone:314-961-1160
Practice Address - Fax:314-961-7822
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant