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General NPI Number Information
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NPI Number | 1326529900
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Entity Type | Organization
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Legal Business Name | LOVELL DOMAIN
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 117 PIRIE RD STE E
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City | OJAI
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State | CA
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Zip | 93023-3166
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Country | US
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Telephone | 805-646-3022
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Fax |
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Provider Business Mailing Address
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Address Line | 5855 OLIVAS PARK DR
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City | VENTURA
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State | CA
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Zip | 93003-7672
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Country | US
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Telephone | 805-667-2801
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Fax | 805-667-2865
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIGITTE V LOVELL
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Credential | DMD
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Telephone | 915-227-9412
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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 |
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License Number State |
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