Provider Demographics
NPI:1164079638
Name:OPSAHL, LAUREN REIKO (DDS)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:REIKO
Last Name:OPSAHL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 ROBESON ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5614
Mailing Address - Country:US
Mailing Address - Phone:910-485-6136
Mailing Address - Fax:910-485-6302
Practice Address - Street 1:912 ROBESON ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5614
Practice Address - Country:US
Practice Address - Phone:910-485-6136
Practice Address - Fax:910-485-6302
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104202122300000X
NC137981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist