Provider Demographics
NPI:1376698431
Name:MAXINE DOVE D.D.S.,PC
Entity Type:Organization
Organization Name:MAXINE DOVE D.D.S.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DOVE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-668-2772
Mailing Address - Street 1:128 STEVENS AVE
Mailing Address - Street 2:1 ST FLOOR
Mailing Address - City:MT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2604
Mailing Address - Country:US
Mailing Address - Phone:914-668-2772
Mailing Address - Fax:914-668-2657
Practice Address - Street 1:128 STEVENS AVE
Practice Address - Street 2:1 ST FLOOR
Practice Address - City:MT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2604
Practice Address - Country:US
Practice Address - Phone:914-668-2772
Practice Address - Fax:914-668-2657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0399061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty