Provider Demographics
NPI:1508902131
Name:SO, LAUREN SAMSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:SAMSON
Last Name:SO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:LAURO
Other - Middle Name:SAMSON
Other - Last Name:SO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1436 E OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93728
Mailing Address - Country:US
Mailing Address - Phone:559-485-0340
Mailing Address - Fax:559-485-0351
Practice Address - Street 1:205 W OLIVE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728
Practice Address - Country:US
Practice Address - Phone:559-485-0340
Practice Address - Fax:559-485-0351
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45775122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist