Provider Demographics
NPI:1710102405
Name:FORE, LAVONNE KELLY (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:LAVONNE
Middle Name:KELLY
Last Name:FORE
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 FOLLY RD STE T
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3907
Mailing Address - Country:US
Mailing Address - Phone:843-642-8100
Mailing Address - Fax:843-566-0706
Practice Address - Street 1:915 FOLLY RD STE T
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3907
Practice Address - Country:US
Practice Address - Phone:843-642-8100
Practice Address - Fax:843-566-0706
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9106-9811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics