Provider Demographics
NPI:1619049475
Name:FORD, LORA BETH (DDS MS)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:BETH
Last Name:FORD
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:BETH
Other - Last Name:HAYNIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1027 CRESTMONT RD
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-7402
Mailing Address - Country:US
Mailing Address - Phone:304-562-5007
Mailing Address - Fax:
Practice Address - Street 1:112 MORRIS ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2911
Practice Address - Country:US
Practice Address - Phone:304-343-2799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV35811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics