Provider Demographics
NPI:1639640303
Name:LOVITROIS DENTAL LLC
Entity Type:Organization
Organization Name:LOVITROIS DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:KALOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-282-8347
Mailing Address - Street 1:5473 ANNE LY LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-1878
Mailing Address - Country:US
Mailing Address - Phone:703-282-8347
Mailing Address - Fax:
Practice Address - Street 1:2316 PENNSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-6706
Practice Address - Country:US
Practice Address - Phone:202-525-5464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC1053749119OtherNPPES
DC069557500Medicaid