Provider Demographics
NPI:1881036671
Name:REIS, LAUREN VAUGHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:VAUGHN
Last Name:REIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:VAUGHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1701 CLARENDON BLVD
Mailing Address - Street 2:SUITE 250-B
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2799
Mailing Address - Country:US
Mailing Address - Phone:703-636-7878
Mailing Address - Fax:703-888-0388
Practice Address - Street 1:1701 CLARENDON BLVD
Practice Address - Street 2:SUITE 250-B
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2799
Practice Address - Country:US
Practice Address - Phone:703-636-7878
Practice Address - Fax:703-888-0388
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014140861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice