Basic Information
| Provider Information | |||||||||
| NPI: | 1528620580 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAWLESS | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1004 NW 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | CANBY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970133454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418687642 | ||||||||
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| Practice Location | |||||||||
| Address1: | 249 NW 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | CANBY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970133601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9712067134 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2019 | ||||||||
| LastUpdateDate: | 06/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | Y | Dental Providers | Dental Hygienist |
No ID Information.