MEDICARE: MS. LORI SUZETTE ANDERSON DDS

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
1	122300000X	Dentist	5411	OK

General Provider Information

NPI Number	:	1750499935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORI SUZETTE ANDERSON DDS

Provider Business Mailing Address
First Line	:	5701 NW 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73127-2231
Country	:	US
Telephone Number	:	405-943-0377
Fax Number	:	405-602-1746

Provider Business Practice Location Address
First Line	:	5701 NW 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73127-2231
Country	:	US
Telephone Number	:	405-943-0377
Fax Number	:	405-602-1746

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2006
Last Update Date	:	04/02/2014

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