Provider Demographics
NPI:1093938219
Name:LOVE, JAMES NICKOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:NICKOLAS
Last Name:LOVE
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 1:215 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-4155
Mailing Address - Country:US
Mailing Address - Phone:903-938-1451
Mailing Address - Fax:903-938-1124
Practice Address - Street 1:215 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-4155
Practice Address - Country:US
Practice Address - Phone:903-938-1451
Practice Address - Fax:903-938-1124
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21104-01OtherTEXAS CHIPS NUMBER
TX1750024OtherUNITED CONCORDIA ID
TX173130901Medicaid
TX470955683OtherDELTA DENTAL NUMBER
TXB21104-01OtherTEXAS CHIPS NUMBER