Provider Demographics
NPI:1457664666
Name:CHAN, LAUREN NICOLE (DDS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLE
Last Name:CHAN
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 1:3077 W JEFFERSON ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-5262
Mailing Address - Country:US
Mailing Address - Phone:815-741-2752
Mailing Address - Fax:
Practice Address - Street 1:3077 W JEFFERSON ST
Practice Address - Street 2:SUITE 208
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5262
Practice Address - Country:US
Practice Address - Phone:815-741-2752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0282571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice