Provider Demographics
NPI:1114149721
Name:LOR, SOMETH (DDS)
Entity Type:Individual
Prefix:
First Name:SOMETH
Middle Name:
Last Name:LOR
Suffix:
Gender:M
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:COVELO
Mailing Address - State:CA
Mailing Address - Zip Code:95428-0247
Mailing Address - Country:US
Mailing Address - Phone:707-983-6404
Mailing Address - Fax:707-983-6184
Practice Address - Street 1:HIGHWAY 162 & BIGGAR LANE
Practice Address - Street 2:
Practice Address - City:COVELO
Practice Address - State:CA
Practice Address - Zip Code:95428-0247
Practice Address - Country:US
Practice Address - Phone:707-983-6404
Practice Address - Fax:707-983-6184
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA411891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1066OtherPIN #
CA41189OtherLICENSE #