Provider Demographics
NPI:1134332521
Name:LORD, BRIAN J (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:LORD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MELVILLE GLEN PL
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4801
Mailing Address - Country:US
Mailing Address - Phone:903-730-6033
Mailing Address - Fax:
Practice Address - Street 1:2253 N LOOP 336 W STE A
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3630
Practice Address - Country:US
Practice Address - Phone:936-539-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT309252122300000X
TX29171122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist