Provider Demographics
NPI:1295029056
Name:OFFUTT, LORNA S (DDS)
Entity Type:Individual
Prefix:
First Name:LORNA
Middle Name:S
Last Name:OFFUTT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 N HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-5536
Mailing Address - Country:US
Mailing Address - Phone:760-446-9011
Mailing Address - Fax:
Practice Address - Street 1:900 N HERITAGE DR
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-5536
Practice Address - Country:US
Practice Address - Phone:760-446-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011015615122300000X
CA64179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist