Provider Demographics
NPI:1730597626
Name:STORTS, LAUREN (DDS)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:STORTS
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 1:1220 MERRICK DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-1824
Mailing Address - Country:US
Mailing Address - Phone:580-223-6720
Mailing Address - Fax:580-223-6724
Practice Address - Street 1:1220 MERRICK DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-1824
Practice Address - Country:US
Practice Address - Phone:802-236-7205
Practice Address - Fax:580-223-6724
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6621122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist