Provider Demographics
NPI:1831254663
Name:PASCHAL, LORI E (DDS)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:E
Last Name:PASCHAL
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:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-0519
Mailing Address - Country:US
Mailing Address - Phone:404-971-2811
Mailing Address - Fax:
Practice Address - Street 1:100 W CHASON ST
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845-1284
Practice Address - Country:US
Practice Address - Phone:404-971-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0117411223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00753871Medicaid
GADN011741OtherSTATE DENTAL LICENSE