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General NPI Number Information
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NPI Number | 1346985504
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Entity Type | Organization
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Legal Business Name | LOVELACE FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 05/02/2022
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Last Update Date | 06/06/2022
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Provider Practice Location Address
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Address Line | 4220 VALLEY RIDGE BLVD STE 101
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City | PONTE VEDRA
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State | FL
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Zip | 32081-5172
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Country | US
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Telephone | 561-719-4835
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Fax |
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Provider Business Mailing Address
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Address Line | 315 ASPEN LEAF DR
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City | PONTE VEDRA
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State | FL
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Zip | 32081-6205
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Country | US
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Telephone | 561-719-4835
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Fax |
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Authorized Official
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Title or Position | GENERAL DENTIST
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Name | DR. JOSHUA RICHARD LOVELACE
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Credential | DMD
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Telephone | 561-719-4835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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