Provider Demographics
NPI:1235205659
Name:DR BRUCE M LOVELACE III A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR BRUCE M LOVELACE III A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:MERLE
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:225-928-0798
Mailing Address - Street 1:8202 KELWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806
Mailing Address - Country:US
Mailing Address - Phone:225-928-0798
Mailing Address - Fax:225-927-8115
Practice Address - Street 1:8202 KELWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-928-0798
Practice Address - Fax:225-927-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty