Provider Demographics
NPI:1992234447
Name:GERDIN, LAUREN JANES (DDS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:JANES
Last Name:GERDIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ELEANOR
Other - Last Name:JANES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3203 STEIN BLVD
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6917
Mailing Address - Country:US
Mailing Address - Phone:715-835-1060
Mailing Address - Fax:
Practice Address - Street 1:3203 STEIN BLVD
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6917
Practice Address - Country:US
Practice Address - Phone:715-835-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001530-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist