MEDICARE: SAMUEL SPENCER LOVEJOY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	34143	TX
2	1223G0001X	General Practice Dentistry	00205878	CO

General Provider Information

NPI Number	:	1134612724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL SPENCER LOVEJOY DMD

Provider Business Mailing Address
First Line	:	1413 POTTER DR STE 104
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1413 POTTER DR STE 104
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-3542
Country	:	US
Telephone Number	:	208-351-4024
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2018
Last Update Date	:	07/18/2024

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