Provider Demographics
NPI:1619435906
Name:LOVELAND DENTAL GROUP OF MOORESVILLE
Entity Type:Organization
Organization Name:LOVELAND DENTAL GROUP OF MOORESVILLE
Other - Org Name:LOVELAND DENTAL GROUP MOORESVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
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:704-997-1835
Mailing Address - Street 1:134 N. MAGNOLIA STREET
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115
Mailing Address - Country:US
Mailing Address - Phone:704-980-9055
Mailing Address - Fax:980-444-9196
Practice Address - Street 1:134 N. MAGNOLIA STREET
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115
Practice Address - Country:US
Practice Address - Phone:704-980-9055
Practice Address - Fax:980-444-9196
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JENNIFER A LOVELAND DMD III PLLC DBA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-06
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty