Provider Demographics
NPI:1851419170
Name:LEBLANC, LORI A (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
Last Name:LEBLANC
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 1:6B PASCO DR
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06088-1708
Mailing Address - Country:US
Mailing Address - Phone:860-627-6123
Mailing Address - Fax:
Practice Address - Street 1:6B PASCO DR
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06088-1708
Practice Address - Country:US
Practice Address - Phone:860-627-6123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008358CT1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice