Provider Demographics
NPI:1407968043
Name:LALLY, LORNA F (DMD)
Entity Type:Individual
Prefix:DR
First Name:LORNA
Middle Name:F
Last Name:LALLY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1696 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1803
Mailing Address - Country:US
Mailing Address - Phone:617-492-1040
Mailing Address - Fax:617-441-7805
Practice Address - Street 1:1696 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1803
Practice Address - Country:US
Practice Address - Phone:617-492-1040
Practice Address - Fax:617-441-7805
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA20281OtherLICENSE