Healthcare Provider Details

I. General information

NPI: 1730655580
Provider Name (Legal Business Name): LOVELL DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E MAIN ST
LOVELL WY
82431
US

IV. Provider business mailing address

240 E MAIN ST
LOVELL WY
82431
US

V. Phone/Fax

Practice location:
  • Phone: 307-548-7654
  • Fax:
Mailing address:
  • Phone: 307-548-7654
  • Fax:

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: DR. LANCE ELDON ANDERSON
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 307-548-7654