Provider Demographics
NPI:1811729742
Name:GADDIS, LAUREN COLLINS (DDS)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:COLLINS
Last Name:GADDIS
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 1:3175 DATA DR APT 3310
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-6456
Mailing Address - Country:US
Mailing Address - Phone:916-990-6821
Mailing Address - Fax:
Practice Address - Street 1:4022 SUNRISE BLVD STE 160
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95742-6908
Practice Address - Country:US
Practice Address - Phone:916-246-1108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1105851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice