Provider Demographics
NPI:1841630381
Name:SYROWIK, LAUREN MF (DDS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:MF
Last Name:SYROWIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:M
Other - Last Name:FRIZZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:33505 W 14 MILE RD
Mailing Address - Street 2:SUITE 70
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1588
Mailing Address - Country:US
Mailing Address - Phone:248-851-1034
Mailing Address - Fax:
Practice Address - Street 1:33505 W 14 MILE RD
Practice Address - Street 2:SUITE 70
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-1588
Practice Address - Country:US
Practice Address - Phone:248-851-1034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010217801223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MNENROLLEDMedicaid