Provider Demographics
NPI:1942991476
Name:WELLER, LAUREN ANN OLSEN (DDS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANN OLSEN
Last Name:WELLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ANN
Other - Last Name:OLSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3053 PINE ST APT 203
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2404
Mailing Address - Country:US
Mailing Address - Phone:435-590-8349
Mailing Address - Fax:
Practice Address - Street 1:1105 HOWARD ST STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2841
Practice Address - Country:US
Practice Address - Phone:402-505-4424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7956122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist