Provider Demographics
NPI:1386086817
Name:LOVE FAMILY DENTAL PC
Entity type:Organization
Organization Name:LOVE FAMILY DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-263-1707
Mailing Address - Street 1:689 STOCKFORD DR
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1460
Mailing Address - Country:US
Mailing Address - Phone:517-263-1707
Mailing Address - Fax:
Practice Address - Street 1:689 STOCKFORD DR
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1460
Practice Address - Country:US
Practice Address - Phone:517-263-1707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010207741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty