1427147404 NPI number — DR. LARRY W LOVERIDGE DMD

Table of content: DR. LARRY W LOVERIDGE DMD (NPI 1427147404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427147404 NPI number — DR. LARRY W LOVERIDGE DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOVERIDGE
Provider First Name:
LARRY
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427147404
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1921 S ARTHUR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNEWICK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99338-1856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-947-3862
Provider Business Mailing Address Fax Number:
509-735-9852

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1921 S ARTHUR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99338-7719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-947-3861
Provider Business Practice Location Address Fax Number:
509-735-9852
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  DE00007618 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5023577 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5036876 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CS10000217 . This is a "CONSCIOUS SEDATION PERMIT" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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