Provider Demographics
NPI:1891989455
Name:NOGA, LORI ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:NOGA
Suffix:
Gender:F
Credentials:DMD
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 2525
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-2525
Mailing Address - Country:US
Mailing Address - Phone:360-943-6331
Mailing Address - Fax:360-943-2293
Practice Address - Street 1:504 UNION AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-1429
Practice Address - Country:US
Practice Address - Phone:360-943-6331
Practice Address - Fax:360-943-2293
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000110301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice