1063666964 NPI number — LARRY W LOVERIDGE, DMD, PLLC

Table of content: (NPI 1063666964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063666964 NPI number — LARRY W LOVERIDGE, DMD, PLLC

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1063666964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2008
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:
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:
99338-1856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-947-3862
Provider Business Practice Location Address Fax Number:
509-735-9885
Provider Enumeration Date:
11/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LOVERIDGE
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PEDIATRIC DENTIST
Authorized Official Telephone Number:
509-947-3862

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , 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".




Copyright © 2007-2025 www.npivalidator.com