Provider Demographics
NPI:1154062933
Name:LOVELL, MARY JOAN (DDS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JOAN
Last Name:LOVELL
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 1:22 FOLLY FIELD RD STE 4A
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-5446
Mailing Address - Country:US
Mailing Address - Phone:920-784-6387
Mailing Address - Fax:
Practice Address - Street 1:181 BLUFFTON RD # 46G104
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6221
Practice Address - Country:US
Practice Address - Phone:843-757-2828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI6000021122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program