Provider Demographics
NPI:1679640858
Name:AIOSA, LORI ANDERSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANDERSON
Last Name:AIOSA
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 1:1894 OSPREY BLUFF BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7937
Mailing Address - Country:US
Mailing Address - Phone:904-215-1866
Mailing Address - Fax:904-215-0952
Practice Address - Street 1:1530 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 2
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-9026
Practice Address - Country:US
Practice Address - Phone:904-215-0980
Practice Address - Fax:904-215-0952
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00130201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN0013020OtherLICENSE NUMBER