Provider Demographics
NPI:1801270301
Name:PHIPPS, LAUREN KRISTINE (DDS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:KRISTINE
Last Name:PHIPPS
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 1:5585 LACENTRE AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ALBERTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55301
Mailing Address - Country:US
Mailing Address - Phone:763-497-7730
Mailing Address - Fax:
Practice Address - Street 1:5585 LA CENTRE AVE STE 500
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55301-4686
Practice Address - Country:US
Practice Address - Phone:763-497-7730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13598122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND13598OtherMINNESOTA BOARD OF DENTISTRY