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General NPI Number Information
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NPI Number | 1366453664
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Entity Type | Organization
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Legal Business Name | BRIDGEVIEW DENTAL
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3801 N CAPITAL OF TEXAS HWY SUITE J240
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City | AUSTIN
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State | TX
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Zip | 78746-1416
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Country | US
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Telephone | 512-347-8299
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Fax | 512-347-7197
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Provider Business Mailing Address
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Address Line | 3801 N CAPITAL OF TEXAS HWY SUITE J240
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City | AUSTIN
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State | TX
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Zip | 78746-1416
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Country | US
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Telephone | 512-347-8299
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Fax | 512-347-7197
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LANCE E LOVELESS
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Credential | D.D.S
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Telephone | 512-347-8299
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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 | 19054
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License Number State | TX
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