Provider Demographics
NPI:1942493804
Name:ANDOCHICK, LORI LYNN (LORI ANDOCHICK)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:LYNN
Last Name:ANDOCHICK
Suffix:
Gender:F
Credentials:LORI ANDOCHICK
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 TRAIL AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4942
Mailing Address - Country:US
Mailing Address - Phone:301-663-3919
Mailing Address - Fax:301-663-1459
Practice Address - Street 1:516 TRAIL AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4942
Practice Address - Country:US
Practice Address - Phone:301-663-3919
Practice Address - Fax:301-663-1459
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10890122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist