Healthcare Provider Details

I. General information

NPI: 1164518684
Provider Name (Legal Business Name): PIA LODBERG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 REGENT STREET 403
BERKELEY CA
94705-2146
US

IV. Provider business mailing address

2999 REGENT STREET 403
BERKELEY CA
94705-2146
US

V. Phone/Fax

Practice location:
  • Phone: 510-843-6341
  • Fax: 510-843-5128
Mailing address:
  • Phone: 510-843-6341
  • Fax: 510-843-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number25328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: