MEDICARE: JOHN JACOB LAUTEN JR. DDS MS

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	122300000X	Dentist	4082	NC

General Provider Information

NPI Number	:	1497731749
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JACOB LAUTEN JR. DDS MS

Provider Business Mailing Address
First Line	:	103 DAVID PL
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-8211
Country	:	US
Telephone Number	:	910-346-8531
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 DAVID PL
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28540-8211
Country	:	US
Telephone Number	:	910-346-8531
Fax Number	:

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	01/31/2013

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