MEDICARE: CG LOVERIDGE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	027025	CA

General Provider Information

NPI Number	:	1952550493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CG LOVERIDGE DMD

Provider Business Mailing Address
First Line	:	1352 LOS OSOS VALLEY RD
Second Line	:	SUITE B
City	:	LOS OSOS
State	:	CA
Zip	:	93402-3343
Country	:	US
Telephone Number	:	805-528-2511
Fax Number	:	805-528-2528

Provider Business Practice Location Address
First Line	:	1352 LOS OSOS VALLEY RD
Second Line	:	SUITE B
City	:	LOS OSOS
State	:	CA
Zip	:	93402-3343
Country	:	US
Telephone Number	:	805-528-2511
Fax Number	:	805-528-2528

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. CRAIG G LOVERIDGE
Credential	:	D.M.D
Telephone Number	:	805-528-2511

Provider Enumeration Date	:	09/09/2008
Last Update Date	:	09/09/2008

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