Individual
LORY CARLISLE AVSAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
4330 HIGHWAY 78 E, SUITE 122, JASPER, AL 35501-8905
(205) 221-1341
(205) 384-1364
Mailing address
3900 DUNBARTON DR, BIRMINGHAM, AL 35223-2741
(205) 253-4969
(205) 384-1364
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
4618
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51501126
BLUE CROSS BLUE SHIELD
AL
Enumeration date
05/09/2007
Last updated
07/08/2007
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