Provider Demographics
NPI:1851309850
Name:WOODBURN, LORI MICHELLE (DDS)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:MICHELLE
Last Name:WOODBURN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9875 WEST LINCOLN HIGHWAY-SUITE 103
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423
Mailing Address - Country:US
Mailing Address - Phone:708-469-9336
Mailing Address - Fax:815-469-1694
Practice Address - Street 1:9875 W LINCOLN HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1930
Practice Address - Country:US
Practice Address - Phone:815-469-9336
Practice Address - Fax:815-469-1694
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026698122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist