Provider Demographics
NPI:1518043595
Name:GOBER, LORI H (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:H
Last Name:GOBER
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 1:340 N. HWY 171
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70611
Mailing Address - Country:US
Mailing Address - Phone:337-855-9955
Mailing Address - Fax:337-855-9956
Practice Address - Street 1:340 N. HWY 171
Practice Address - Street 2:SUITE A
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70611
Practice Address - Country:US
Practice Address - Phone:337-855-9955
Practice Address - Fax:337-855-9956
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA42791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice