Healthcare Provider Details

I. General information

NPI: 1205723384
Provider Name (Legal Business Name): LAUREN BROOKE BLUM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 BELAIR RD
NOTTINGHAM MD
21236-1106
US

IV. Provider business mailing address

200 MAEVE CT
PIKESVILLE MD
21208-1422
US

V. Phone/Fax

Practice location:
  • Phone: 410-256-2044
  • Fax:
Mailing address:
  • Phone: 443-992-9436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number18489
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: