Healthcare Provider Details

I. General information

NPI: 1063947125
Provider Name (Legal Business Name): LOVETTSVILLE DENTAL ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N LIGHT ST
LOVETTSVILLE VA
20180-8613
US

IV. Provider business mailing address

2 N LIGHT ST
LOVETTSVILLE VA
20180-8613
US

V. Phone/Fax

Practice location:
  • Phone: 540-822-4224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRANDON MEYER
Title or Position: OWNER
Credential:
Phone: 540-822-4224