Provider Demographics
NPI:1326024506
Name:ANDERSON, LORI K (DDS)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:K
Last Name:ANDERSON
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 1:2525 W. CAREFREE HWY STE 108
Mailing Address - Street 2:STE 108
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085
Mailing Address - Country:US
Mailing Address - Phone:623-455-9179
Mailing Address - Fax:623-466-0139
Practice Address - Street 1:2525 W. CAREFREE HWY STE 108
Practice Address - Street 2:STE 108
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085
Practice Address - Country:US
Practice Address - Phone:623-455-9179
Practice Address - Fax:623-466-0139
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ49891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice