Provider Demographics
NPI:1164622189
Name:MUSICK, LORI BALL (DDS)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:BALL
Last Name:MUSICK
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:PO BOX 700
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-0700
Mailing Address - Country:US
Mailing Address - Phone:276-964-7418
Mailing Address - Fax:276-964-6465
Practice Address - Street 1:107 TAZEWELL AVE
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2250
Practice Address - Country:US
Practice Address - Phone:276-964-7418
Practice Address - Fax:276-964-6465
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014118501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9202523Medicaid