Provider Demographics
NPI:1275986788
Name:LOVELAND DENTAL GROUP
Entity Type:Organization
Organization Name:LOVELAND DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LOVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-998-1835
Mailing Address - Street 1:19315 W CATAWBA AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8650
Mailing Address - Country:US
Mailing Address - Phone:704-655-0630
Mailing Address - Fax:
Practice Address - Street 1:19315 W CATAWBA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8650
Practice Address - Country:US
Practice Address - Phone:704-655-0630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10111122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty