MEDICARE: LAUREN E. STANDEFER, DDS, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	24559	TX

General Provider Information

NPI Number	:	1316375876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAUREN E. STANDEFER, DDS, PA

Provider Business Mailing Address
First Line	:	2300 VIRGINIA PKWY
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-3504
Country	:	US
Telephone Number	:	372-542-8733
Fax Number	:

Provider Business Practice Location Address
First Line	:	2300 VIRGINIA PKWY
Second Line	:
City	:	MCKINNEY
State	:	TX
Zip	:	75071-3504
Country	:	US
Telephone Number	:	372-542-8733
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LAUREN ELIZABTEH STANDEFER
Credential	:	DDS
Telephone Number	:	979-575-0406

Provider Enumeration Date	:	10/21/2013
Last Update Date	:	10/21/2013

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