Healthcare Provider Details

I. General information

NPI: 1629091087
Provider Name (Legal Business Name): LORA DIANE SITTON D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W WASHINGTON ST
PRINCETON KY
42445-1938
US

IV. Provider business mailing address

400 W WASHINGTON ST
PRINCETON KY
42445-1938
US

V. Phone/Fax

Practice location:
  • Phone: 270-365-6174
  • Fax: 270-365-6174
Mailing address:
  • Phone: 270-365-6174
  • Fax: 270-365-6174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7351
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7351
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: