Provider Demographics
NPI:1346985504
Name:LOVELACE FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:LOVELACE FAMILY DENTISTRY, LLC
Other - Org Name:LOVELACE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-719-4835
Mailing Address - Street 1:315 ASPEN LEAF DR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-6205
Mailing Address - Country:US
Mailing Address - Phone:561-719-4835
Mailing Address - Fax:
Practice Address - Street 1:4220 VALLEY RIDGE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-5172
Practice Address - Country:US
Practice Address - Phone:561-719-4835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty