Provider Demographics
NPI:1821653981
Name:HEISINGER, LAUREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:HEISINGER
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 1:30 STARBUCK DR UNIT 118
Mailing Address - Street 2:
Mailing Address - City:GREEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12183-1263
Mailing Address - Country:US
Mailing Address - Phone:516-528-9846
Mailing Address - Fax:
Practice Address - Street 1:9 CENTURY HILL DR
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2113
Practice Address - Country:US
Practice Address - Phone:518-785-3911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
NY0619531223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program