Healthcare Provider Details

I. General information

NPI: 1720366156
Provider Name (Legal Business Name): LAUREN KISLEY-DOOMS D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37241 EUCLID AVE
WILLOUGHBY OH
44094-5656
US

IV. Provider business mailing address

37241 EUCLID AVE
WILLOUGHBY OH
44094-5656
US

V. Phone/Fax

Practice location:
  • Phone: 440-951-6550
  • Fax: 440-951-6528
Mailing address:
  • Phone: 440-951-6550
  • Fax: 440-951-6528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.023446
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: