Provider Demographics
NPI:1639394554
Name:YUN, LAUREN A (DDS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:A
Last Name:YUN
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 1:467 S RIVERSHORE LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-4978
Mailing Address - Country:US
Mailing Address - Phone:208-938-1247
Mailing Address - Fax:208-939-4975
Practice Address - Street 1:467 S RIVERSHORE LN
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-4978
Practice Address - Country:US
Practice Address - Phone:208-938-1247
Practice Address - Fax:208-939-4975
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD32191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice