Provider Demographics
NPI:1306225602
Name:POWELL, LAUREN N (DDS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:N
Last Name:POWELL
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 1:3315 RANCH ROAD 620 S STE 250
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6873
Mailing Address - Country:US
Mailing Address - Phone:512-402-9090
Mailing Address - Fax:512-402-9091
Practice Address - Street 1:3315 RANCH ROAD 620 S STE 250
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78738-6873
Practice Address - Country:US
Practice Address - Phone:512-402-9090
Practice Address - Fax:512-402-9091
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60635081122300000X
WARR60560221390200000X
TX38212122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program