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General NPI Number Information
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NPI Number | 1184277402
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Entity Type | Individual
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Provider Name | NATHAN LOUGHRIDGE DDS, MS
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Gender | Male
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Dates
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Enumeration Date | 07/17/2019
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 5138 CEDAR VILLAGE DR
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City | MASON
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State | OH
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Zip | 45040-3717
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Country | US
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Telephone | 513-336-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 1602 AMBERLEY CT
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City | XENIA
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State | OH
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Zip | 45385-2696
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Country | US
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Telephone | 937-522-5138
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | ETN699
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 30.026767
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License Number State | OH
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