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General NPI Number Information
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NPI Number | 1164533840
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Entity Type | Organization
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Legal Business Name | J.W. LOVE DENTAL ASSOICATE, P.C.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1816 INDEPENDENCE SQ SUITE B
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City | ATLANTA
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State | GA
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Zip | 30338-5150
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Country | US
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Telephone | 770-399-9199
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Fax |
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Provider Business Mailing Address
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Address Line | 1816 INDEPENDENCE SQ SUITE B
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City | ATLANTA
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State | GA
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Zip | 30338-5150
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Country | US
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Telephone | 770-399-9199
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. J. WALKER LOVE
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Credential | D.D.S.
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Telephone | 770-399-9199
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN11878
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License Number State | GA
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