Provider Demographics
NPI:1003848938
Name:LOVATO, KAREN (DDS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:LOVATO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15421 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-9002
Mailing Address - Country:US
Mailing Address - Phone:425-316-8095
Mailing Address - Fax:
Practice Address - Street 1:15421 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-9002
Practice Address - Country:US
Practice Address - Phone:425-316-8095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE602204691223E0200X
NMDD27561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice