Provider Demographics
NPI:1538865183
Name:DRS J LOVELAND AND R WALKER IV, LLC
Entity type:Organization
Organization Name:DRS J LOVELAND AND R WALKER IV, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LOVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:704-960-2492
Mailing Address - Street 1:19315 W CATAWBA AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8651
Mailing Address - Country:US
Mailing Address - Phone:704-960-2492
Mailing Address - Fax:
Practice Address - Street 1:749 STOCKBRIDGE DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7200
Practice Address - Country:US
Practice Address - Phone:704-960-2492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental