Provider Demographics
NPI:1629633136
Name:GLEASON, LAUREN KELLY AKEMI (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN KELLY
Middle Name:AKEMI
Last Name:GLEASON
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 1:16520 BAKE PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618
Mailing Address - Country:US
Mailing Address - Phone:949-660-1321
Mailing Address - Fax:949-679-9336
Practice Address - Street 1:16520 BAKE PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618
Practice Address - Country:US
Practice Address - Phone:949-660-1321
Practice Address - Fax:949-679-9336
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1027221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice