Healthcare Provider Details

I. General information

NPI: 1770955114
Provider Name (Legal Business Name): LAUREN TRANCIK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2015
Last Update Date: 10/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 LAURENCE AVE
JACKSON MI
49202-2983
US

IV. Provider business mailing address

1030 LAURENCE AVE
JACKSON MI
49202-2983
US

V. Phone/Fax

Practice location:
  • Phone: 517-782-1467
  • Fax:
Mailing address:
  • Phone: 517-782-1467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901021756
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12012398A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: