Provider Demographics
NPI:1790165819
Name:POOLE, LAUREN ELLIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ELLIS
Last Name:POOLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:5055 MARYLAND WAY STE 202
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7664
Mailing Address - Country:US
Mailing Address - Phone:828-242-8698
Mailing Address - Fax:
Practice Address - Street 1:5055 MARYLAND WAY STE 202
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7664
Practice Address - Country:US
Practice Address - Phone:615-600-4830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10038122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist