Provider Demographics
NPI:1629339353
Name:LORI A NOGA, DMD, PLLC
Entity Type:Organization
Organization Name:LORI A NOGA, DMD, PLLC
Other - Org Name:TRANQUILITY DENTAL WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOGA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-529-9968
Mailing Address - Street 1:8050 FREEDOM LN NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-4747
Mailing Address - Country:US
Mailing Address - Phone:360-529-9968
Mailing Address - Fax:
Practice Address - Street 1:8050 FREEDOM LN NE
Practice Address - Street 2:SUITE C
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-4747
Practice Address - Country:US
Practice Address - Phone:360-529-9968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00011030261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental