Provider Demographics
NPI:1508444035
Name:VIEIRA, LAUREN (DMD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:VIEIRA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E SHORT ST UNIT 319
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507-1593
Mailing Address - Country:US
Mailing Address - Phone:347-475-6382
Mailing Address - Fax:
Practice Address - Street 1:2953 BROAD AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-2957
Practice Address - Country:US
Practice Address - Phone:901-842-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11632122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist