Provider Demographics
NPI:1306418975
Name:LOVAJ, TAYING (DDS)
Entity type:Individual
Prefix:
First Name:TAYING
Middle Name:
Last Name:LOVAJ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-9012
Mailing Address - Country:US
Mailing Address - Phone:920-265-9455
Mailing Address - Fax:
Practice Address - Street 1:1030A DULUTH HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5215
Practice Address - Country:US
Practice Address - Phone:770-995-1957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002637-15122300000X
MND14591122300000X
GADN122462122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist