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NPI Code Detail

MEDICARE: LORELEI E CLAIBORNE D.D.S

MEDICARE: LORELEI E CLAIBORNE D.D.S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223D0001XPublic Health Dentistry2901015933MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083604276
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORELEI E CLAIBORNE D.D.S
Provider Business Mailing Address
First Line : 5635 W FORT ST
Second Line :
City : DETROIT
State : MI
Zip : 48209-3154
Country : US
Telephone Number : 313-849-3920
Fax Number : 313-849-0824
Provider Business Practice Location Address
First Line : 5635 W FORT ST
Second Line :
City : DETROIT
State : MI
Zip : 48209-3154
Country : US
Telephone Number : 313-849-3920
Fax Number : 313-849-0824
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2005
Last Update Date : 07/08/2007

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Directions to “ LORELEI E CLAIBORNE D.D.S” Practice Location

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