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General NPI Number Information
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NPI Number | 1952550493
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Entity Type | Organization
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Legal Business Name | CG LOVERIDGE DMD
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | 1352 LOS OSOS VALLEY RD SUITE B
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City | LOS OSOS
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State | CA
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Zip | 93402-3343
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Country | US
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Telephone | 805-528-2511
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Fax | 805-528-2528
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Provider Business Mailing Address
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Address Line | 1352 LOS OSOS VALLEY RD SUITE B
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City | LOS OSOS
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State | CA
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Zip | 93402-3343
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Country | US
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Telephone | 805-528-2511
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Fax | 805-528-2528
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Authorized Official
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Title or Position | DENTIST
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Name | DR. CRAIG G LOVERIDGE
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Credential | D.M.D
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Telephone | 805-528-2511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 027025
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License Number State | CA
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