Provider Demographics
NPI:1083894703
Name:DOROBA, LORI BETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:BETH
Last Name:DOROBA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LORI
Other - Middle Name:BETH
Other - Last Name:GELLERSTEDT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:518 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3760
Mailing Address - Country:US
Mailing Address - Phone:309-764-9099
Mailing Address - Fax:
Practice Address - Street 1:518 19TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3760
Practice Address - Country:US
Practice Address - Phone:309-764-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice