| Randall L Lonsbrough D D S Inc | |
|
628 California Blvd Suite F1 San Luis Obispo CA 93401-2542 | |
| (805) 544-3204 | |
| Not Available |
| Full Name | Randall L Lonsbrough D D S Inc |
|---|---|
| Speciality | Dentist |
| Location | 628 California Blvd, San Luis Obispo, California |
| Authorized Official Name and Position | Randall L Lonsbrough (DENTIST/OWNER) |
| Authorized Official Contact | 8055443204 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Randall L Lonsbrough D D S Inc 628 California Blvd Suite F1 San Luis Obispo CA 93401-2542 Ph: (805) 544-3204 | Randall L Lonsbrough D D S Inc 628 California Blvd Suite F1 San Luis Obispo CA 93401-2542 Ph: (805) 544-3204 |
| NPI Number | 1841515202 |
|---|---|
| Provider Enumeration Date | 03/29/2010 |
| Last Update Date | 08/11/2010 |
| Medicare PECOS PAC ID | 8426180514 |
|---|---|
| Medicare Enrollment ID | O20100726000484 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841515202 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0700X | Dentist - Prosthodontics | (* (Not Available)) | Primary |
| Provider Name | Randall L Lonsbrough |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1750397410 PECOS PAC ID: 5991837072 Enrollment ID: I20100726000455 |
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