Provider Demographics
NPI:1942339098
Name:STEVENS, LORIE MILLER (DMD MAGD)
Entity Type:Individual
Prefix:DR
First Name:LORIE
Middle Name:MILLER
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DMD MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5129 CLEVELAND HWY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506
Mailing Address - Country:US
Mailing Address - Phone:770-983-0123
Mailing Address - Fax:770-983-3244
Practice Address - Street 1:5129 CLEVELAND HWY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30506
Practice Address - Country:US
Practice Address - Phone:770-983-0123
Practice Address - Fax:770-983-3244
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAD01070A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice