Provider Demographics
NPI:1588703888
Name:ASSOCIATED DENTAL CARE OF NORTH WINDHAM, LLC
Entity type:Organization
Organization Name:ASSOCIATED DENTAL CARE OF NORTH WINDHAM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELACE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-649-0238
Mailing Address - Street 1:387 TUCKIE RD STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH WINDHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06256-1355
Mailing Address - Country:US
Mailing Address - Phone:860-456-8814
Mailing Address - Fax:
Practice Address - Street 1:387 TUCKIE RD STE B
Practice Address - Street 2:
Practice Address - City:NORTH WINDHAM
Practice Address - State:CT
Practice Address - Zip Code:06256-1355
Practice Address - Country:US
Practice Address - Phone:860-456-8814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT50391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty