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Individual

DALLAS W LOVELACE III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
3000 SAINT MATTHEWS RD, ORANGEBURG, SC 29118-1442
(803) 395-2200
Mailing address
PO BOX 1245, ORANGEBURG, SC 29116-1245
(803) 395-4497
(803) 536-0998

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5221
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
400685
SC
05
GP1426
SC
Enumeration date
11/09/2006
Last updated
11/23/2009
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