MEDICARE: LOVIKA KALRA

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	DS042283	PA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	1223P0221X	Pediatric Dentistry	DS042283	PA

General Provider Information

NPI Number	:	1588158372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOVIKA KALRA

Provider Business Mailing Address
First Line	:	31 S EAGLE RD
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-3340
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 S EAGLE RD
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-3340
Country	:	US
Telephone Number	:	484-454-3568
Fax Number	:

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

Provider Enumeration Date	:	06/15/2018
Last Update Date	:	11/16/2020

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