Basic Information
Provider Information
NPI: 1487639787
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KONDO
FirstName: LAUREN
MiddleName: G
NamePrefix:  
NameSuffix:  
Credential: D.D.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX A D
Address2:  
City: YUBA CITY
State: CA
PostalCode: 959921396
CountryCode: US
TelephoneNumber: 5307513769
FaxNumber: 5307511237
Practice Location
Address1: 4941 OLIVEHURST AVE
Address2:  
City: OLIVEHURST
State: CA
PostalCode: 959614225
CountryCode: US
TelephoneNumber: 5307434614
FaxNumber: 5307431883
Other Information
ProviderEnumerationDate: 12/08/2005
LastUpdateDate: 07/01/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X34511CAY Dental ProvidersDentistGeneral Practice

No ID Information.


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