Provider Demographics
NPI:1689786121
Name:LAUSELL, CHRISTIAN (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:LAUSELL
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 1:1021 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-3034
Mailing Address - Country:US
Mailing Address - Phone:972-262-8191
Mailing Address - Fax:
Practice Address - Street 1:1021 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-3034
Practice Address - Country:US
Practice Address - Phone:972-262-8191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice