Provider Demographics
NPI:1295056299
Name:JADEJA, LAUREN SCARBOROUGH (DMD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:SCARBOROUGH
Last Name:JADEJA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3819 MURRELL RD STE G
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4752
Mailing Address - Country:US
Mailing Address - Phone:321-433-1717
Mailing Address - Fax:
Practice Address - Street 1:3819 MURRELL RD STE G
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955
Practice Address - Country:US
Practice Address - Phone:321-433-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19007122300000X
VT016.0076954122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1019105Medicaid
VT0160076954OtherLICENSE
VTDN19007OtherDEA