Provider Demographics
NPI:1760405112
Name:GEARHART, LORI (DMD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:GEARHART
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 1:1618 S ALABAMA AVE
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36460-3078
Mailing Address - Country:US
Mailing Address - Phone:251-743-3123
Mailing Address - Fax:251-575-5965
Practice Address - Street 1:1618 S ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460-3078
Practice Address - Country:US
Practice Address - Phone:251-743-3123
Practice Address - Fax:251-575-5965
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3785122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-90115OtherBCBS
AL510-90115OtherBCBS