Provider Demographics
NPI:1497731749
Name:LAUTEN, JOHN JACOB JR (DDS MS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JACOB
Last Name:LAUTEN
Suffix:JR
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 DAVID PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-8211
Mailing Address - Country:US
Mailing Address - Phone:910-346-8531
Mailing Address - Fax:
Practice Address - Street 1:103 DAVID PL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-8211
Practice Address - Country:US
Practice Address - Phone:910-346-8531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4082122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist