Provider Demographics
NPI:1053491670
Name:LOVE, JEFFREY LEON (DDS)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LEON
Last Name:LOVE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:LEON
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1400 GREENWAY COURT
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330
Mailing Address - Country:US
Mailing Address - Phone:919-774-3707
Mailing Address - Fax:919-774-4021
Practice Address - Street 1:1400 GREENWAY COURT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330
Practice Address - Country:US
Practice Address - Phone:919-774-3707
Practice Address - Fax:919-774-4021
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC105161122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U39131Medicare UPIN
NC8995395Medicare ID - Type Unspecified