Provider Demographics
NPI:1063577088
Name:LORI, ALDAN J (DDS)
Entity type:Individual
Prefix:DR
First Name:ALDAN
Middle Name:J
Last Name:LORI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 704
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:PA
Mailing Address - Zip Code:18471-0704
Mailing Address - Country:US
Mailing Address - Phone:570-563-1839
Mailing Address - Fax:
Practice Address - Street 1:531 CLINTON ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:PA
Practice Address - Zip Code:18471-7703
Practice Address - Country:US
Practice Address - Phone:570-563-1839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA019396L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice