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General NPI Number Information
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NPI Number | 1114149721
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Entity Type | Individual
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Provider Name | SOMETH LOR D.D.S
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | HIGHWAY 162 & BIGGAR LANE
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City | COVELO
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State | CA
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Zip | 95428-0247
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Country | US
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Telephone | 707-983-6404
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Fax | 707-983-6184
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Provider Business Mailing Address
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Address Line | PO BOX 247
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City | COVELO
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State | CA
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Zip | 95428-0247
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Country | US
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Telephone | 707-983-6404
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Fax | 707-983-6184
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 41189
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License Number State | CA
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