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General NPI Number Information
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NPI Number | 1841515202
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Entity Type | Organization
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Legal Business Name | RANDALL L LONSBROUGH D D S INC
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Dates
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Enumeration Date | 03/29/2010
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 628 CALIFORNIA BLVD SUITE F1
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2542
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Country | US
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Telephone | 805-544-3204
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Fax |
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Provider Business Mailing Address
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Address Line | 628 CALIFORNIA BLVD SUITE F1
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-2542
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Country | US
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Telephone | 805-544-3204
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. RANDALL L LONSBROUGH
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Credential | DDS
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Telephone | 805-544-3204
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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