Provider Demographics
NPI:1669686713
Name:AVSAR, LORY CARLISLE (DMD)
Entity Type:Individual
Prefix:
First Name:LORY
Middle Name:CARLISLE
Last Name:AVSAR
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 1:3900 DUNBARTON DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2741
Mailing Address - Country:US
Mailing Address - Phone:205-253-4969
Mailing Address - Fax:205-384-1364
Practice Address - Street 1:4330 HIGHWAY 78 E
Practice Address - Street 2:SUITE 122
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8905
Practice Address - Country:US
Practice Address - Phone:205-221-1341
Practice Address - Fax:205-384-1364
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL46181223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51501126OtherBLUE CROSS BLUE SHIELD