Provider Demographics
NPI:1720191752
Name:LOVELESS, SHAUN MARSHALL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:MARSHALL
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 1:1843 IDA RED RD
Mailing Address - Street 2:
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-2873
Mailing Address - Country:US
Mailing Address - Phone:260-343-0568
Mailing Address - Fax:260-343-0761
Practice Address - Street 1:1843 IDA RED RD
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755-2873
Practice Address - Country:US
Practice Address - Phone:260-343-0568
Practice Address - Fax:260-343-0761
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009973A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice