Provider Demographics
NPI:1700378221
Name:LOR, SANDY (DMD)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:LOR
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 1:123 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JAFFREY
Mailing Address - State:NH
Mailing Address - Zip Code:03452-7104
Mailing Address - Country:US
Mailing Address - Phone:603-532-8720
Mailing Address - Fax:
Practice Address - Street 1:123 MAIN ST
Practice Address - Street 2:
Practice Address - City:JAFFREY
Practice Address - State:NH
Practice Address - Zip Code:03452
Practice Address - Country:US
Practice Address - Phone:603-532-8720
Practice Address - Fax:603-532-5618
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857972122300000X
NH04434122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist