Provider Demographics
NPI:1518183060
Name:THURMON, LAUREN SYDNEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:SYDNEY
Last Name:THURMON
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 1:10720 LINKWOOD CT
Mailing Address - Street 2:APT 1216
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2955
Mailing Address - Country:US
Mailing Address - Phone:504-453-9156
Mailing Address - Fax:
Practice Address - Street 1:7926 WRENWOOD BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1786
Practice Address - Country:US
Practice Address - Phone:225-216-2252
Practice Address - Fax:225-216-2254
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5742122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1857424Medicaid