Provider Demographics
NPI:1619000122
Name:LOVERIDGE, CRAIG GORDON (DMD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:GORDON
Last Name:LOVERIDGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2238 BAY VIEW HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402
Mailing Address - Country:US
Mailing Address - Phone:805-528-2511
Mailing Address - Fax:805-528-2528
Practice Address - Street 1:2238 BAY VIEW HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402
Practice Address - Country:US
Practice Address - Phone:805-528-2511
Practice Address - Fax:805-528-2528
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice