MEDICARE: BRIDGEVIEW DENTAL

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	122300000X	Dentist	19054	TX

General Provider Information

NPI Number	:	1366453664
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIDGEVIEW DENTAL

Provider Business Mailing Address
First Line	:	3801 N CAPITAL OF TEXAS HWY
Second Line	:	SUITE J240
City	:	AUSTIN
State	:	TX
Zip	:	78746-1416
Country	:	US
Telephone Number	:	512-347-8299
Fax Number	:	512-347-7197

Provider Business Practice Location Address
First Line	:	3801 N CAPITAL OF TEXAS HWY
Second Line	:	SUITE J240
City	:	AUSTIN
State	:	TX
Zip	:	78746-1416
Country	:	US
Telephone Number	:	512-347-8299
Fax Number	:	512-347-7197

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LANCE E LOVELESS
Credential	:	D.D.S
Telephone Number	:	512-347-8299

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	08/22/2020

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Directions to “BRIDGEVIEW DENTAL ” Practice Location

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