Healthcare Provider Details

I. General information

NPI: 1639640303
Provider Name (Legal Business Name): LOVITROIS DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2018
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2316 PENNSYLVANIA AVE SE
WASHINGTON DC
20020-6706
US

IV. Provider business mailing address

5473 ANNE LY LN
ALEXANDRIA VA
22310-1878
US

V. Phone/Fax

Practice location:
  • Phone: 202-525-5464
  • Fax:
Mailing address:
  • Phone: 703-282-8347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LOUIS B KALOMBO
Title or Position: OWNER
Credential: DDS
Phone: 703-282-8347