Provider Demographics
NPI:1669672002
Name:MALITZ, LAUREN BAUTSCH (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:BAUTSCH
Last Name:MALITZ
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 1:2815 W LAKE HOUSTON PKWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-5227
Mailing Address - Country:US
Mailing Address - Phone:281-361-2011
Mailing Address - Fax:281-360-6517
Practice Address - Street 1:2815 W LAKE HOUSTON PKWY
Practice Address - Street 2:SUITE 107
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-5227
Practice Address - Country:US
Practice Address - Phone:281-361-2011
Practice Address - Fax:281-360-6517
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist