Healthcare Provider Details

I. General information

NPI: 1497746119
Provider Name (Legal Business Name): LAUREN ANN HALL-TATE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 12/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N HOMER ST
LANSING MI
48912-4741
US

IV. Provider business mailing address

200 N HOMER ST
LANSING MI
48912-4741
US

V. Phone/Fax

Practice location:
  • Phone: 517-351-9070
  • Fax: 517-351-6036
Mailing address:
  • Phone: 517-351-9070
  • Fax: 517-351-6036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901013605
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: