Provider Demographics
NPI:1174614465
Name:GOVERNALE, LAUREN M (DMD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:M
Last Name:GOVERNALE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:MARILYNN
Other - Last Name:GOVERNALE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1907 COUNTESS CT
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1005
Mailing Address - Country:US
Mailing Address - Phone:239-592-7609
Mailing Address - Fax:
Practice Address - Street 1:7007 LELY CULTURAL PKWY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-8976
Practice Address - Country:US
Practice Address - Phone:239-775-3052
Practice Address - Fax:239-775-7035
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN105071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0758132Medicaid