Individual
DR. LORA WONDERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
4616 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6826
(260) 432-8596
Mailing address
4616 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6826
(260) 432-8596
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12011879A
IN
1223G0001X
General Practice Dentistry
30.023620
OH
Other
Enumeration date
04/08/2011
Last updated
07/13/2016
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