Provider Demographics
NPI:1528220506
Name:LOVELESS, RYAN HARVEL (DDS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:HARVEL
Last Name:LOVELESS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8309 SIRINGO PASS
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-2736
Mailing Address - Country:US
Mailing Address - Phone:713-376-2927
Mailing Address - Fax:512-346-1865
Practice Address - Street 1:7800 N MOPAC EXPY STE 330
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8959
Practice Address - Country:US
Practice Address - Phone:512-346-5540
Practice Address - Fax:512-346-1865
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX240521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice