Provider Demographics
NPI:1952620817
Name:THRAILKILL, LORI ELLEN (DMD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ELLEN
Last Name:THRAILKILL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MASSINGILL RD
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-8213
Mailing Address - Country:US
Mailing Address - Phone:864-878-2428
Mailing Address - Fax:
Practice Address - Street 1:108 MASSINGILL RD
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-8213
Practice Address - Country:US
Practice Address - Phone:864-878-2428
Practice Address - Fax:864-878-3080
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC7116122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program