=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275682874
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. THOMAS LOVINGGOOD DDS MS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3010 S STATE ROUTE 291 SUITE R
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64057-2676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-373-2227
-----------------------------------------------------
Fax | 816-373-3046
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3010 S STATE ROUTE 291 SUITE R
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64057-2676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-373-2227
-----------------------------------------------------
Fax | 816-373-3046
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. THOMAS A LOVINGGOOD
-----------------------------------------------------
Credential | DDS MS
-----------------------------------------------------
Telephone | 816-373-2227
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | 12918
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------