Healthcare Provider Details

I. General information

NPI: 1386337806
Provider Name (Legal Business Name): LAUREN KVAM SULIER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAUREN SUZANNE KVAM

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S CAMINO DEL RIO
DURANGO CO
81303-6826
US

IV. Provider business mailing address

555 S CAMINO DEL RIO
DURANGO CO
81303-6826
US

V. Phone/Fax

Practice location:
  • Phone: 970-259-2264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00205594
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: