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General NPI Number Information
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NPI Number | 1659660306
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Entity Type | Organization
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Legal Business Name | KHOA NGUYEN DMD & KRISTEN LOVELACE DMD PC
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 04/04/2011
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Provider Practice Location Address
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Address Line | 1200 SICKLERVILLE ROAD
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City | SICKLERVILLE
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State | NJ
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Zip | 08081
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Country | US
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Telephone | 856-885-8162
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Fax | 856-885-8175
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Provider Business Mailing Address
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Address Line | 1200 SICKLERVILLE ROAD
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City | SICKLERVILLE
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State | NJ
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Zip | 08081
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Country | US
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Telephone | 856-885-8162
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Fax | 856-885-8175
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Authorized Official
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Title or Position | DENTIST/CO-OWNER
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Name | DR. KRISTEN LOVELACE
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Credential | D.M.D.
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Telephone | 856-875-1339
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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 | 22DI02126100
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License Number State | NJ
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