Provider Demographics
NPI:1659660306
Name:KHOA NGUYEN DMD & KRISTEN LOVELACE DMD PC
Entity Type:Organization
Organization Name:KHOA NGUYEN DMD & KRISTEN LOVELACE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-875-1339
Mailing Address - Street 1:1200 SICKLERVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081
Mailing Address - Country:US
Mailing Address - Phone:856-885-8162
Mailing Address - Fax:856-885-8175
Practice Address - Street 1:1200 SICKLERVILLE ROAD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081
Practice Address - Country:US
Practice Address - Phone:856-885-8162
Practice Address - Fax:856-885-8175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI021261001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty