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General NPI Number Information
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NPI Number | 1225313315
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Entity Type | Organization
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Legal Business Name | LOVING CARE DENTAL LLC
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Dates
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Enumeration Date | 10/20/2011
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Last Update Date | 10/20/2011
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Provider Practice Location Address
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Address Line | 93 HOME PL 1 ST FLOOR
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City | LODI
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State | NJ
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Zip | 07644-1513
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Country | US
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Telephone | 973-365-0189
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Fax | 973-365-0534
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Provider Business Mailing Address
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Address Line | 93 HOME PL 1 ST FLOOR
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City | LODI
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State | NJ
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Zip | 07644-1513
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Country | US
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Telephone | 973-365-0189
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Fax | 973-365-0534
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Authorized Official
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Title or Position | OWNER
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Name | DR. DMITRY KUCHER
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Credential | DDS
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Telephone | 973-444-0909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02003000
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License Number State | NJ
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