Provider Demographics
NPI:1609570225
Name:LOVELL ORTRHODONTICS, PC
Entity Type:Organization
Organization Name:LOVELL ORTRHODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADIMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-759-8155
Mailing Address - Street 1:1849 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5035
Mailing Address - Country:US
Mailing Address - Phone:970-880-0965
Mailing Address - Fax:970-251-8208
Practice Address - Street 1:48 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3209
Practice Address - Country:US
Practice Address - Phone:970-880-0965
Practice Address - Fax:970-251-8208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty