MEDICARE: LORI MICHELLE WOODBURN 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	019026698	IL

General Provider Information

NPI Number	:	1851309850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI MICHELLE WOODBURN DDS

Provider Business Mailing Address
First Line	:	9875 WEST LINCOLN HIGHWAY-SUITE 103
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423
Country	:	US
Telephone Number	:	708-469-9336
Fax Number	:	815-469-1694

Provider Business Practice Location Address
First Line	:	9875 W LINCOLN HWY
Second Line	:	SUITE 103
City	:	FRANKFORT
State	:	IL
Zip	:	60423-1930
Country	:	US
Telephone Number	:	815-469-9336
Fax Number	:	815-469-1694

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	01/24/2017

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