Provider Demographics
NPI:1245774900
Name:LOVELL, DANIEL ANDREW (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ANDREW
Last Name:LOVELL
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1616
Mailing Address - Country:US
Mailing Address - Phone:309-266-6705
Mailing Address - Fax:309-266-1242
Practice Address - Street 1:320 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1616
Practice Address - Country:US
Practice Address - Phone:309-266-6705
Practice Address - Fax:309-266-1242
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190277231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics