Provider Demographics
NPI:1467571240
Name:WILLIAMS, LAUREN BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:BRUCE
Last Name:WILLIAMS
Suffix:
Gender:M
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:PO BOX 460
Mailing Address - Street 2:107 GRANT STREET
Mailing Address - City:SALISBURY
Mailing Address - State:PA
Mailing Address - Zip Code:15558-0460
Mailing Address - Country:US
Mailing Address - Phone:814-662-2737
Mailing Address - Fax:814-662-2738
Practice Address - Street 1:95 GRANT STREET
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:PA
Practice Address - Zip Code:15558
Practice Address - Country:US
Practice Address - Phone:814-662-2737
Practice Address - Fax:814-662-2737
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025121L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010392060001Medicaid