Provider Demographics
NPI:1174971238
Name:STEDDUM, LAUREN SULLIVAN (DMD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:SULLIVAN
Last Name:STEDDUM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:MARIE
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12713 AMORETTO WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-6236
Mailing Address - Country:US
Mailing Address - Phone:919-395-4095
Mailing Address - Fax:
Practice Address - Street 1:12713 AMORETTO WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-6236
Practice Address - Country:US
Practice Address - Phone:919-395-4095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice