MEDICARE: MR. MICHAEL ROY LOVELACE DDS

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	122300000X	Dentist	19760	TX

General Provider Information

NPI Number	:	1972543882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ROY LOVELACE DDS

Provider Business Mailing Address
First Line	:	710 W PRINCETON DR
Second Line	:
City	:	PRINCETON
State	:	TX
Zip	:	75407-9039
Country	:	US
Telephone Number	:	972-734-3336
Fax Number	:	469-519-0163

Provider Business Practice Location Address
First Line	:	710 W PRINCETON DR
Second Line	:
City	:	PRINCETON
State	:	TX
Zip	:	75407-9039
Country	:	US
Telephone Number	:	972-734-3336
Fax Number	:	469-519-0163

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	03/05/2015

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