Provider Demographics
NPI:1962026393
Name:LOVELACE, JOSHUA R (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:R
Last Name:LOVELACE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 VALLEY RIDGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-5172
Mailing Address - Country:US
Mailing Address - Phone:904-345-0339
Mailing Address - Fax:
Practice Address - Street 1:4220 VALLEY RIDGE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-5172
Practice Address - Country:US
Practice Address - Phone:904-345-0339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN249111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice