Provider Demographics
NPI:1700445889
Name:LAUREN F. CALLISON, DMD, LLC
Entity Type:Organization
Organization Name:LAUREN F. CALLISON, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:FORSTER
Authorized Official - Last Name:CALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-532-7329
Mailing Address - Street 1:402 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8328
Mailing Address - Country:US
Mailing Address - Phone:843-532-7329
Mailing Address - Fax:
Practice Address - Street 1:1133 N JEFFERIES BLVD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2729
Practice Address - Country:US
Practice Address - Phone:843-549-5584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty