Provider Demographics
NPI:1265777197
Name:LOVELL FAMILY DENTISTRY, PC
Entity type:Organization
Organization Name:LOVELL FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-484-1675
Mailing Address - Street 1:5717 CHURCHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-3308
Mailing Address - Country:US
Mailing Address - Phone:757-484-1675
Mailing Address - Fax:757-686-8902
Practice Address - Street 1:5717 CHURCHLAND BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3308
Practice Address - Country:US
Practice Address - Phone:757-484-1675
Practice Address - Fax:757-686-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014114961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty