Healthcare Provider Details

I. General information

NPI: 1538086749
Provider Name (Legal Business Name): BRANDON LOVERUDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4944 FRANKLIN AVE STE A
DES MOINES IA
50310-1952
US

IV. Provider business mailing address

225 SE ORALABOR RD STE 3
ANKENY IA
50021-9118
US

V. Phone/Fax

Practice location:
  • Phone: 515-277-0222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS-10471
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: