Provider Demographics
NPI:1841515202
Name:RANDALL L LONSBROUGH D D S INC
Entity type:Organization
Organization Name:RANDALL L LONSBROUGH D D S INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:L
Authorized Official - Last Name:LONSBROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-544-3204
Mailing Address - Street 1:628 CALIFORNIA BLVD
Mailing Address - Street 2:SUITE F1
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2542
Mailing Address - Country:US
Mailing Address - Phone:805-544-3204
Mailing Address - Fax:
Practice Address - Street 1:628 CALIFORNIA BLVD
Practice Address - Street 2:SUITE F1
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2542
Practice Address - Country:US
Practice Address - Phone:805-544-3204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty