Healthcare Provider Details

I. General information

NPI: 1134033723
Provider Name (Legal Business Name): FOR THE LOVE OF TEETH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 MANCHESTER RD
BELGRADE ME
04917-3823
US

IV. Provider business mailing address

270 MANCHESTER RD
BELGRADE ME
04917-3823
US

V. Phone/Fax

Practice location:
  • Phone: 901-538-8591
  • Fax:
Mailing address:
  • Phone: 901-538-8591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number StateNULL

VIII. Authorized Official

Name: RONDA AVERY
Title or Position: OWNER IPDH
Credential: IPDH, RDH
Phone: 901-538-8591