Provider Demographics
NPI:1619381746
Name:LORKOVICH, LEAH MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:MARIE
Last Name:LORKOVICH
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:BOX 6216A
Mailing Address - Street 2:MEDICAL STAFF SERVICE PROFESSION
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-6148
Mailing Address - Country:US
Mailing Address - Phone:843-228-5149
Mailing Address - Fax:843-228-5728
Practice Address - Street 1:NAVAL HOSPITAL BEAUFORT
Practice Address - Street 2:BOX 6216A ATTN MEDICAL STAFF SERVICE PROFESSIONAL
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:29902-6148
Practice Address - Country:US
Practice Address - Phone:843-228-5149
Practice Address - Fax:843-228-5728
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040016122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist