MEDICARE: DR. JOSEPH HENRY LOVASKO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	12006616A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000084419	OTHER	IN	BC BS PROVIDER PIN NUMBER
2	476023	OTHER	IN	UNITED CONCORDIA NUMBER
3	000000084418	OTHER	IN	BC BS PROVIDER PIN NUMBER

General Provider Information

NPI Number	:	1043291800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH HENRY LOVASKO D.D.S.

Provider Business Mailing Address
First Line	:	601 W US HIGHWAY 30
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-2656
Country	:	US
Telephone Number	:	219-322-0501
Fax Number	:	219-322-0577

Provider Business Practice Location Address
First Line	:	601 W US HIGHWAY 30
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-2656
Country	:	US
Telephone Number	:	219-322-0501
Fax Number	:	219-322-0577

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	07/09/2007

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Directions to “ DR. JOSEPH HENRY LOVASKO D.D.S.” Practice Location

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