Provider Demographics
NPI:1255062410
Name:BEDRO, LAUREN LYNNE (DDS)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:LYNNE
Last Name:BEDRO
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 1:9091 WOODLORE SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-3499
Mailing Address - Country:US
Mailing Address - Phone:734-748-9162
Mailing Address - Fax:
Practice Address - Street 1:601 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48933-2424
Practice Address - Country:US
Practice Address - Phone:517-485-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601383122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist