Provider Demographics
NPI:1083604276
Name:CLAIBORNE, LORELEI E (DDS)
Entity Type:Individual
Prefix:
First Name:LORELEI
Middle Name:E
Last Name:CLAIBORNE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5635 W FORT ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-3154
Mailing Address - Country:US
Mailing Address - Phone:313-849-3920
Mailing Address - Fax:313-849-0824
Practice Address - Street 1:5635 W FORT ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48209-3154
Practice Address - Country:US
Practice Address - Phone:313-849-3920
Practice Address - Fax:313-849-0824
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010159331223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2915665Medicaid