Provider Demographics
NPI:1871845206
Name:LOVELL, JOEL W (DMD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:W
Last Name:LOVELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HILLCREST DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-2200
Mailing Address - Country:US
Mailing Address - Phone:309-444-3811
Mailing Address - Fax:309-444-8393
Practice Address - Street 1:100 HILLCREST DR
Practice Address - Street 2:SUITE C
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-2200
Practice Address - Country:US
Practice Address - Phone:309-444-3811
Practice Address - Fax:309-444-8393
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL319.0181001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice