Provider Demographics
NPI:1114454287
Name:LOVINGER, KIM, & KHZOUZ DENTAL CORPORATION
Entity Type:Organization
Organization Name:LOVINGER, KIM, & KHZOUZ DENTAL CORPORATION
Other - Org Name:GOLDEN AGE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:LOVINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DA
Authorized Official - Phone:847-778-9527
Mailing Address - Street 1:701 S RAYMOND AVE STE 4B
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-5201
Mailing Address - Country:US
Mailing Address - Phone:714-992-2999
Mailing Address - Fax:
Practice Address - Street 1:701 S RAYMOND AVE STE 4B
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-5201
Practice Address - Country:US
Practice Address - Phone:714-992-2999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty