Provider Demographics
NPI:1033306675
Name:DOVE, JON BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:BRUCE
Last Name:DOVE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W BOUNDARY ST
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1201
Mailing Address - Country:US
Mailing Address - Phone:419-872-9191
Mailing Address - Fax:
Practice Address - Street 1:601 W BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1201
Practice Address - Country:US
Practice Address - Phone:419-872-9191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH19539122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH803897OtherUNITED CONCORDIA PROVIDER