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General NPI Number Information
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NPI Number | 1639640303
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Entity Type | Organization
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Legal Business Name | LOVITROIS DENTAL LLC
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 2316 PENNSYLVANIA AVE SE
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City | WASHINGTON
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State | DC
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Zip | 20020-6706
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Country | US
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Telephone | 202-525-5464
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Fax |
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Provider Business Mailing Address
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Address Line | 5473 ANNE LY LN
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City | ALEXANDRIA
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State | VA
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Zip | 22310-1878
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Country | US
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Telephone | 703-282-8347
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LOUIS B KALOMBO
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Credential | DDS
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Telephone | 703-282-8347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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