Provider Demographics
NPI:1629091087
Name:SITTON, LORA DIANE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LORA
Middle Name:DIANE
Last Name:SITTON
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 1:400 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-1938
Mailing Address - Country:US
Mailing Address - Phone:270-365-6174
Mailing Address - Fax:270-365-6174
Practice Address - Street 1:400 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-1938
Practice Address - Country:US
Practice Address - Phone:270-365-6174
Practice Address - Fax:270-365-6174
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY73511223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60073517Medicaid