Provider Demographics
NPI:1013015668
Name:LOVE, PATRICK JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:JAMES
Last Name:LOVE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:PATRICK
Other - Middle Name:J
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:805 S 4J RD
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-4132
Mailing Address - Country:US
Mailing Address - Phone:307-682-6655
Mailing Address - Fax:307-686-1816
Practice Address - Street 1:805 S 4J RD
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4132
Practice Address - Country:US
Practice Address - Phone:307-682-6655
Practice Address - Fax:307-686-1816
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYWY-6901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice