Healthcare Provider Details

I. General information

NPI: 1275653875
Provider Name (Legal Business Name): SAMUEL KENT LAUSON DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16756 E SMOKY HILL RD
AURORA CO
80015-2470
US

IV. Provider business mailing address

16756 E SMOKY HILL RD
AURORA CO
80015-2470
US

V. Phone/Fax

Practice location:
  • Phone: 303-690-0400
  • Fax: 303-680-1157
Mailing address:
  • Phone: 303-690-0400
  • Fax: 303-680-1157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number841565954
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: