Provider Demographics
NPI:1427147404
Name:LOVERIDGE, LARRY W (DMD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:W
Last Name:LOVERIDGE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 S ARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-1856
Mailing Address - Country:US
Mailing Address - Phone:509-947-3862
Mailing Address - Fax:509-735-9852
Practice Address - Street 1:1921 S ARTHUR ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338-7719
Practice Address - Country:US
Practice Address - Phone:509-947-3861
Practice Address - Fax:509-735-9852
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000076181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5023577Medicaid
WA5036876Medicaid
WACS10000217OtherCONSCIOUS SEDATION PERMIT
WACS10000217OtherCONSCIOUS SEDATION PERMIT