Provider Demographics
NPI:1629244694
Name:LORI J NETTLETON D.D.S., INC
Entity Type:Organization
Organization Name:LORI J NETTLETON D.D.S., INC
Other - Org Name:LA JOLLA SHORES DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LORI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:NETTLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-459-9772
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32883261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental