Provider Demographics
NPI:1902128218
Name:SANTARUFO, LAUREN NICOLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:NICOLE
Last Name:SANTARUFO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 EASTOVER DR STE 150
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-6326
Mailing Address - Country:US
Mailing Address - Phone:601-353-8459
Mailing Address - Fax:601-355-5212
Practice Address - Street 1:1200 EASTOVER DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-6317
Practice Address - Country:US
Practice Address - Phone:601-355-5212
Practice Address - Fax:601-355-5212
Is Sole Proprietor?:No
Enumeration Date:2010-02-28
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3731-141223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223G0001XDental ProvidersDentistGeneral Practice