Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | TX |
NPI | 1073622296 |
---|---|
Provider Name | Dr. Teri Lovelace |
First Address | Abilene, TX 79605-6221 |
Second Address | Abilene, TX 79605-6221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |