Provider Demographics
NPI:1144236423
Name:LOR, PASE (DDS FICOI)
Entity type:Individual
Prefix:DR
First Name:PASE
Middle Name:
Last Name:LOR
Suffix:
Gender:M
Credentials:DDS FICOI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE A
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103
Mailing Address - Country:US
Mailing Address - Phone:651-489-3681
Mailing Address - Fax:651-489-4452
Practice Address - Street 1:491 UNIVERSITY AVE W
Practice Address - Street 2:SUITE A
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103
Practice Address - Country:US
Practice Address - Phone:651-489-3681
Practice Address - Fax:651-489-4452
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10632122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist