Provider Demographics
NPI:1265179105
Name:MCNAMARA, LORI ANNE (RDH, PHDH)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:ANNE
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:RDH, PHDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 S ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-2630
Mailing Address - Country:US
Mailing Address - Phone:630-805-0726
Mailing Address - Fax:
Practice Address - Street 1:46 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-2630
Practice Address - Country:US
Practice Address - Phone:630-805-0726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist