MEDICARE: ASSOCIATED DENTAL CARE OF NORTH WINDHAM, LLC

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	5039	CT

General Provider Information

NPI Number	:	1588703888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATED DENTAL CARE OF NORTH WINDHAM, LLC

Provider Business Mailing Address
First Line	:	387 TUCKIE RD STE B
Second Line	:
City	:	NORTH WINDHAM
State	:	CT
Zip	:	06256-1355
Country	:	US
Telephone Number	:	860-456-8814
Fax Number	:

Provider Business Practice Location Address
First Line	:	387 TUCKIE RD STE B
Second Line	:
City	:	NORTH WINDHAM
State	:	CT
Zip	:	06256-1355
Country	:	US
Telephone Number	:	860-456-8814
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEVEN LOVELACE
Credential	:	DMD
Telephone Number	:	860-649-0238

Provider Enumeration Date	:	02/05/2007
Last Update Date	:	08/22/2020

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