Provider Demographics
NPI:1548501018
Name:CALLISON, LAUREN FORSTER (DMD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:FORSTER
Last Name:CALLISON
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 1:105 HISTORY LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-7850
Mailing Address - Country:US
Mailing Address - Phone:843-352-7998
Mailing Address - Fax:
Practice Address - Street 1:1133 N JEFFERIES BLVD
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2729
Practice Address - Country:US
Practice Address - Phone:843-549-5584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC80961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice