Provider Demographics
NPI:1417948902
Name:LOREI, SHAGHAYEAGH (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHAGHAYEAGH
Middle Name:
Last Name:LOREI
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 1:215 LOURDES DR
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:PA
Mailing Address - Zip Code:16417-9713
Mailing Address - Country:US
Mailing Address - Phone:814-774-8154
Mailing Address - Fax:
Practice Address - Street 1:374TH DENTAL SQUADRON
Practice Address - Street 2:UNIT 5224
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96328
Practice Address - Country:JP
Practice Address - Phone:01181311-755-3670
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD129301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice