Provider Demographics
NPI:1497746119
Name:HALL-TATE, LAUREN ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ANN
Last Name:HALL-TATE
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 1:200 N HOMER ST
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4741
Mailing Address - Country:US
Mailing Address - Phone:517-351-9070
Mailing Address - Fax:517-351-6036
Practice Address - Street 1:200 N HOMER ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-4741
Practice Address - Country:US
Practice Address - Phone:517-351-9070
Practice Address - Fax:517-351-6036
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist