Healthcare Provider Details

I. General information

NPI: 1255884664
Provider Name (Legal Business Name): LOVIK KARMELL DDS, DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 08/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E ALMOND AVE STE 3
MADERA CA
93637-5600
US

IV. Provider business mailing address

500 E ALMOND AVE STE 3
MADERA CA
93637-5600
US

V. Phone/Fax

Practice location:
  • Phone: 559-661-7000
  • Fax: 559-674-7173
Mailing address:
  • Phone: 559-661-7000
  • Fax: 559-674-7173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KARMELL RAFISOLYMAN
Title or Position: DENTIST
Credential: DDS
Phone: 559-661-7000