MEDICARE: DR. LOVEGEL MAYOR DEALCA 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	1223G0001X	General Practice Dentistry	55461	CA
2	1223G0001X	General Practice Dentistry	5494	NV

General Provider Information

NPI Number	:	1962546606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOVEGEL MAYOR DEALCA D.D.S.

Provider Business Mailing Address
First Line	:	1238 E CHAMPLAIN DR
Second Line	:	APT 208
City	:	FRESNO
State	:	CA
Zip	:	93720-5069
Country	:	US
Telephone Number	:	702-480-9155
Fax Number	:

Provider Business Practice Location Address
First Line	:	2670 S JONES BLVD
Second Line	:	STE 1
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-5341
Country	:	US
Telephone Number	:	702-880-9527
Fax Number	:

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	06/23/2008

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Directions to “ DR. LOVEGEL MAYOR DEALCA D.D.S.” Practice Location

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