Provider Demographics
NPI:1710181227
Name:CARDELLINO, LORI ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ANN
Last Name:CARDELLINO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1186 PITTSFIELD LN
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3853
Mailing Address - Country:US
Mailing Address - Phone:805-535-8866
Mailing Address - Fax:
Practice Address - Street 1:3922 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3637
Practice Address - Country:US
Practice Address - Phone:805-535-8866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice