Provider Demographics
NPI:1366453664
Name:BRIDGEVIEW DENTAL
Entity Type:Organization
Organization Name:BRIDGEVIEW DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOVELESS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-347-8299
Mailing Address - Street 1:3801 N CAPITAL OF TEXAS HWY
Mailing Address - Street 2:SUITE J240
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-1416
Mailing Address - Country:US
Mailing Address - Phone:512-347-8299
Mailing Address - Fax:512-347-7197
Practice Address - Street 1:3801 N CAPITAL OF TEXAS HWY
Practice Address - Street 2:SUITE J240
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-1416
Practice Address - Country:US
Practice Address - Phone:512-347-8299
Practice Address - Fax:512-347-7197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19054122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty