Provider Demographics
NPI:1740672393
Name:WILLIAM A LOVELL, III, DMD
Entity type:Organization
Organization Name:WILLIAM A LOVELL, III, DMD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ADRIAN
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-318-2601
Mailing Address - Street 1:1900 28TH AVE S
Mailing Address - Street 2:SUITE 109
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2687
Mailing Address - Country:US
Mailing Address - Phone:205-957-6611
Mailing Address - Fax:
Practice Address - Street 1:1900 28TH AVE S
Practice Address - Street 2:SUITE 109
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-2687
Practice Address - Country:US
Practice Address - Phone:205-957-6611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL58161223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1639461155Medicaid