Provider Demographics
NPI:1528373164
Name:AUS, LORI KILLEN (RDH, MA)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:KILLEN
Last Name:AUS
Suffix:
Gender:F
Credentials:RDH, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2574 TROY CT
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-7306
Mailing Address - Country:US
Mailing Address - Phone:503-657-5046
Mailing Address - Fax:
Practice Address - Street 1:412 NE FORD ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4608
Practice Address - Country:US
Practice Address - Phone:503-434-7477
Practice Address - Fax:503-472-9731
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1599124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist