Provider Demographics
NPI:1407548167
Name:ANDERSON, LAUREN KAY (DMD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:KAY
Last Name:ANDERSON
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1280
Mailing Address - Country:US
Mailing Address - Phone:334-793-5697
Mailing Address - Fax:334-793-9521
Practice Address - Street 1:2019 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1280
Practice Address - Country:US
Practice Address - Phone:334-793-5697
Practice Address - Fax:334-793-9521
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007320-C11223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice