Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN010526 | GA |
NPI | 1457319030 |
---|---|
Provider Name | Lorraine W Lafontaine |
First Address | Lawrenceville, GA 30046-0897 |
Second Address | Buford, GA 30518-2560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 08/07/2007 |