Provider Demographics
NPI:1316058431
Name:SA, LORENA TADDEI (DDS, MSD)
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:TADDEI
Last Name:SA
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 N US HIGHWAY 75 STE 900-A
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2546
Mailing Address - Country:US
Mailing Address - Phone:903-487-0349
Mailing Address - Fax:
Practice Address - Street 1:2916 N US HIGHWAY 75 STE 900-A
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2546
Practice Address - Country:US
Practice Address - Phone:903-487-0349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24755122300000X, 1223G0001X
GADN0131081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA144285292AMedicaid