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General NPI Number Information
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NPI Number | 1184865370
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Entity Type | Individual
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Provider Name | LORA CHONGRUK DMD
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Gender | Female
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Dates
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Enumeration Date | 03/17/2009
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Last Update Date | 01/11/2026
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Provider Practice Location Address
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Address Line | PSC 475 BOX 1
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City | FPO
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State | AP
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Zip | 96350-1200
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Country | US
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Telephone | 315-243-3546
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 475 BOX 1
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City | FPO
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State | AP
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Zip | 96350-1200
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Country | US
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Telephone |
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Fax |
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DE60100287
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 021.002294
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License Number State | IL
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