Provider Demographics
NPI:1336797083
Name:HARTZOG, LAUREN ZIEGLER (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ZIEGLER
Last Name:HARTZOG
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 1:5619 BELMONT AVE APT 4222
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-6893
Mailing Address - Country:US
Mailing Address - Phone:843-422-5548
Mailing Address - Fax:
Practice Address - Street 1:4518 ROWLETT RD
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-5081
Practice Address - Country:US
Practice Address - Phone:843-422-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC94481223G0001X
TX392501223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice