Provider Demographics
NPI:1235154493
Name:LOVLIEN, THOMAS C
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:LOVLIEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 BEASER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-3616
Mailing Address - Country:US
Mailing Address - Phone:715-682-5958
Mailing Address - Fax:715-682-5462
Practice Address - Street 1:1419 BEASER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-3616
Practice Address - Country:US
Practice Address - Phone:715-682-5958
Practice Address - Fax:715-682-5462
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics