Provider Demographics
NPI:1750896783
Name:LOVELAND, KELCEY
Entity type:Individual
Prefix:
First Name:KELCEY
Middle Name:
Last Name:LOVELAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KELCEY
Other - Middle Name:
Other - Last Name:LOVELAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:9201 EAGLE RANCH RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-6032
Mailing Address - Country:US
Mailing Address - Phone:505-553-3607
Mailing Address - Fax:
Practice Address - Street 1:9201 EAGLE RANCH RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-6032
Practice Address - Country:US
Practice Address - Phone:505-553-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD48241223X0400X
NV69881223X0400X
NMDD1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics