Provider Demographics
NPI:1033323332
Name:GREEN, LORI ANN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:GREEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 CALVARY AVE
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-3303
Mailing Address - Country:US
Mailing Address - Phone:610-965-0890
Mailing Address - Fax:
Practice Address - Street 1:SHH DENTAL CENTER - SIGAL CENTER
Practice Address - Street 2:450 CHEW ST., SUITE 201
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18049-3303
Practice Address - Country:US
Practice Address - Phone:610-776-4802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH009849L124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist