Provider Demographics
NPI:1265577332
Name:LAUTT, ADAM GARY (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:GARY
Last Name:LAUTT
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:355 N LANTANA ST PMB #410
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6038
Mailing Address - Country:US
Mailing Address - Phone:805-573-5613
Mailing Address - Fax:
Practice Address - Street 1:1730 S VICTORIA AVE STE 250
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6167
Practice Address - Country:US
Practice Address - Phone:805-650-1080
Practice Address - Fax:805-650-1087
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA472761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics