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NPI Code Detail

MEDICARE: LORI ROAM

MEDICARE:   LORI  ROAM
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
1126800000XDental Assistant

General Provider Information

NPI Number : 1699228668
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORI ROAM
Provider Business Mailing Address
First Line : 4TH WEST & VIRGINIA AVE
Second Line : BLDG 500
City : FORT LEONARD WOOD
State : MO
Zip : 65473
Country : US
Telephone Number : 573-596-0408
Fax Number :
Provider Business Practice Location Address
First Line : 5047 VIRGINIA AVE
Second Line : BLDG 500
City : FORT LEONARD WOOD
State : MO
Zip : 65473-9126
Country : US
Telephone Number : 573-596-0408
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2016
Last Update Date : 07/26/2016

Similar Medicare Providers

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Practice Location Address:
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1922451277 — APRIL BLISS
Practice Location Address:
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Practice Fax: 573-596-0314

Directions to “ LORI ROAM ” Practice Location

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