Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 5590 | WA |
NPI | 1043439938 |
---|---|
Provider Name | Anthony Thomas Lovrovich |
First Address | Seattle, WA 98105-3941 |
Second Address | Seattle, WA 98105-3941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7980 | DOH UNIQUE IDENTIFIER NUM (01) | WA |