Individual
LAUREN NICOLE CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
190.031987
IL
1223P0221X
Pediatric Dentistry
Primary
12013113A
IN
Other
Enumeration date
06/26/2017
Last updated
07/17/2019
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