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General NPI Number Information
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NPI Number | 1316362163
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Entity Type | Organization
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Legal Business Name | LEAH K. LOVETT, D.M.D., P.A.
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Dates
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Enumeration Date | 03/03/2014
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Last Update Date | 03/03/2014
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Provider Practice Location Address
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Address Line | 510 AIRPORT CENTER DR STE. 101
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City | JACKSONVILLE
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State | FL
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Zip | 32218-7260
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Country | US
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Telephone | 904-683-7079
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Fax | 904-329-1383
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Provider Business Mailing Address
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Address Line | 510 AIRPORT CENTER DR STE. 101
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City | JACKSONVILLE
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State | FL
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Zip | 32218-7260
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Country | US
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Telephone | 904-683-7079
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Fax | 904-329-1383
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. LEAH KATHLEEN LOVETT
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Credential | D.M.D.
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Telephone | 904-683-7079
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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 | DN17552
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License Number State | FL
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