Provider Demographics
NPI:1073768768
Name:LOVE, MELANIE R (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:R
Last Name:LOVE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 W BROAD ST STE 440
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3318
Mailing Address - Country:US
Mailing Address - Phone:703-241-2911
Mailing Address - Fax:703-534-3521
Practice Address - Street 1:450 W BROAD ST STE 440
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3318
Practice Address - Country:US
Practice Address - Phone:703-241-2911
Practice Address - Fax:703-534-3521
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA076001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice