Provider Demographics
NPI:1457319030
Name:LAFONTAINE, LORRAINE W (DDS)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:W
Last Name:LAFONTAINE
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 897
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-0897
Mailing Address - Country:US
Mailing Address - Phone:770-339-4260
Mailing Address - Fax:770-963-6322
Practice Address - Street 1:2755 SAWNEE AVE
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-2560
Practice Address - Country:US
Practice Address - Phone:770-614-2427
Practice Address - Fax:770-614-2449
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0105261223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health