Provider Demographics
NPI:1972721827
Name:SURBER, LORENA M (DDS)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:M
Last Name:SURBER
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 1:1031 QUARRIER ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-2317
Mailing Address - Country:US
Mailing Address - Phone:304-343-0361
Mailing Address - Fax:304-343-6711
Practice Address - Street 1:1031 QUARRIER ST
Practice Address - Street 2:SUITE 403
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2317
Practice Address - Country:US
Practice Address - Phone:304-343-0361
Practice Address - Fax:304-343-6711
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3045122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist