Provider Demographics
NPI:1154548311
Name:LORIZ, TYRA (DMD, PA)
Entity type:Individual
Prefix:DR
First Name:TYRA
Middle Name:
Last Name:LORIZ
Suffix:
Gender:F
Credentials:DMD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3298 SUMMIT BLVD
Mailing Address - Street 2:49
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-8318
Mailing Address - Country:US
Mailing Address - Phone:850-433-3008
Mailing Address - Fax:850-469-1008
Practice Address - Street 1:3298 SUMMIT BLVD
Practice Address - Street 2:49
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-8318
Practice Address - Country:US
Practice Address - Phone:850-433-3008
Practice Address - Fax:850-469-1008
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00123471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice