Provider Demographics
NPI:1952550493
Name:CG LOVERIDGE DMD
Entity Type:Organization
Organization Name:CG LOVERIDGE DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:G
Authorized Official - Last Name:LOVERIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:805-528-2511
Mailing Address - Street 1:1352 LOS OSOS VALLEY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3343
Mailing Address - Country:US
Mailing Address - Phone:805-528-2511
Mailing Address - Fax:805-528-2528
Practice Address - Street 1:1352 LOS OSOS VALLEY RD
Practice Address - Street 2:SUITE B
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3343
Practice Address - Country:US
Practice Address - Phone:805-528-2511
Practice Address - Fax:805-528-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA027025261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental