Provider Demographics
NPI:1245329713
Name:LOVELACE, BRUCE MERLE III
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MERLE
Last Name:LOVELACE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8202 KELWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4801
Mailing Address - Country:US
Mailing Address - Phone:225-928-0798
Mailing Address - Fax:225-927-8115
Practice Address - Street 1:8202 KELWOOD AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4801
Practice Address - Country:US
Practice Address - Phone:225-928-0798
Practice Address - Fax:225-927-8115
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA31701223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA58345Medicare ID - Type UnspecifiedMEDICARE NUMBER