MEDICARE: MS. LAUREN BRENN MARTIN DDS

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	4495	AR

General Provider Information

NPI Number	:	1326676602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREN BRENN MARTIN DDS

Provider Business Mailing Address
First Line	:	4 WILCOX CV
Second Line	:
City	:	PARAGOULD
State	:	AR
Zip	:	72450-7471
Country	:	US
Telephone Number	:	870-270-9230
Fax Number	:

Provider Business Practice Location Address
First Line	:	2011 N VAN BUREN ST
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72207-4739
Country	:	US
Telephone Number	:	501-438-0282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2020
Last Update Date	:	08/20/2021

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