Provider Demographics
NPI:1881605186
Name:CROW, LORA L
Entity type:Individual
Prefix:DR
First Name:LORA
Middle Name:L
Last Name:CROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N ILLINOIS ST
Mailing Address - Street 2:SUITE 1770
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1904
Mailing Address - Country:US
Mailing Address - Phone:317-237-2225
Mailing Address - Fax:317-237-2228
Practice Address - Street 1:201 N ILLINOIS ST
Practice Address - Street 2:SUITE 1770
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1904
Practice Address - Country:US
Practice Address - Phone:317-237-2225
Practice Address - Fax:317-237-2228
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120099091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice