Provider Demographics
NPI:1174950059
Name:LAUREN E BURGER DDS LLC
Entity type:Organization
Organization Name:LAUREN E BURGER DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BURGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-667-9181
Mailing Address - Street 1:28977 WALKER RD S STE E
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785-6049
Mailing Address - Country:US
Mailing Address - Phone:225-667-9181
Mailing Address - Fax:225-667-9180
Practice Address - Street 1:30125 WALKER RD N
Practice Address - Street 2:
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-7302
Practice Address - Country:US
Practice Address - Phone:225-667-9181
Practice Address - Fax:225-667-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2880624Medicaid