Provider Demographics
NPI:1033385000
Name:NETTLETON, LORI J (D D S INC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:NETTLETON
Suffix:
Gender:F
Credentials:D D S INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 PASEO DEL OCASO
Mailing Address - Street 2:SUITE A
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-3115
Mailing Address - Country:US
Mailing Address - Phone:858-459-9772
Mailing Address - Fax:858-459-9774
Practice Address - Street 1:8100 PASEO DEL OCASO
Practice Address - Street 2:SUITE A
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-3115
Practice Address - Country:US
Practice Address - Phone:858-459-9772
Practice Address - Fax:858-459-9774
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32883122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist