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General NPI Number Information
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NPI Number | 1851428932
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Entity Type | Individual
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Provider Name | MAURICE P. LORD II D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 415 N 26TH ST SUITE 300
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City | LAFAYETTE
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State | IN
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Zip | 47904-2895
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Country | US
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Telephone | 765-447-6858
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Fax | 765-446-1001
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Provider Business Mailing Address
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Address Line | 415 N 26TH ST. SUITE 300
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City | LAFAYETTE
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State | IN
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Zip | 47904
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Country | US
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Telephone | 765-447-6858
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Fax | 765-446-1001
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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 | 6121
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License Number State | IN
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