Provider Demographics
NPI:1750499935
Name:ANDERSON, LORI SUZETTE (DDS)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:SUZETTE
Last Name:ANDERSON
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 1:5701 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-2231
Mailing Address - Country:US
Mailing Address - Phone:405-943-0377
Mailing Address - Fax:405-602-1746
Practice Address - Street 1:5701 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-2231
Practice Address - Country:US
Practice Address - Phone:405-943-0377
Practice Address - Fax:405-602-1746
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5411122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist