Provider Demographics
NPI:1982917076
Name:STUMP, LAUREN ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:ELIZABETH
Last Name:STUMP
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 1:140 STONERIDGE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RUCKERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22968-3096
Mailing Address - Country:US
Mailing Address - Phone:317-379-0550
Mailing Address - Fax:
Practice Address - Street 1:140 STONERIDGE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:RUCKERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22968-3096
Practice Address - Country:US
Practice Address - Phone:317-379-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6572-015122300000X
VA0401413528122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist