Provider Demographics
NPI:1952530388
Name:PETERSON, LAUREN KATHLEEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:KATHLEEN
Last Name:PETERSON
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 1:10050 W 41ST AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4157
Mailing Address - Country:US
Mailing Address - Phone:303-940-0125
Mailing Address - Fax:303-424-9989
Practice Address - Street 1:10050 W 41ST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4157
Practice Address - Country:US
Practice Address - Phone:303-940-0125
Practice Address - Fax:303-424-9989
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2016-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice