Provider Demographics
NPI:1821072588
Name:TIMMONS, LAUREN L (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:L
Last Name:TIMMONS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 BIENVILLE BLVD
Mailing Address - Street 2:SUITE N-1
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3052
Mailing Address - Country:US
Mailing Address - Phone:228-875-6055
Mailing Address - Fax:228-875-6360
Practice Address - Street 1:2112 BIENVILLE BLVD
Practice Address - Street 2:SUITE N-1
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3052
Practice Address - Country:US
Practice Address - Phone:228-875-6055
Practice Address - Fax:228-875-6360
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3224-02122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist