=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376698431
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAXINE DOVE D.D.S.,PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 128 STEVENS AVE 1 ST FLOOR
-----------------------------------------------------
City | MT VERNON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10550-2604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-668-2772
-----------------------------------------------------
Fax | 914-668-2657
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 128 STEVENS AVE 1 ST FLOOR
-----------------------------------------------------
City | MT VERNON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10550-2604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-668-2772
-----------------------------------------------------
Fax | 914-668-2657
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MAXINE E DOVE
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 914-668-2772
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 039906
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------