Provider Demographics
NPI:1770868382
Name:POLITO, LAUREN LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:LEE
Last Name:POLITO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 HIGHWAY 54 W STE 100
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4542
Mailing Address - Country:US
Mailing Address - Phone:770-461-6465
Mailing Address - Fax:770-461-2888
Practice Address - Street 1:1233 HIGHWAY 54 W STE 100
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4542
Practice Address - Country:US
Practice Address - Phone:770-461-6465
Practice Address - Fax:770-461-2888
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202137122300000X
NMDD4474122300000X
GADN014262122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist