Provider Demographics
NPI:1043988470
Name:SANDY LOR DMD LLC
Entity Type:Organization
Organization Name:SANDY LOR DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-502-8848
Mailing Address - Street 1:1088 W BOYLSTON ST APT C
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2070
Mailing Address - Country:US
Mailing Address - Phone:978-502-8848
Mailing Address - Fax:
Practice Address - Street 1:1010 MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:MA
Practice Address - Zip Code:01520-1237
Practice Address - Country:US
Practice Address - Phone:508-829-3292
Practice Address - Fax:508-829-9323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty