=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659506582
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFREY LOVE DDS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2009
-----------------------------------------------------
Last Update Date | 05/21/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 GREENWAY CT
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27330-6953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-774-3707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 GREENWAY CT
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27330-6953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-774-3707
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JEFFREY L LOVE
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 919-774-3707
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 105161
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------