Provider Demographics
NPI:1598099004
Name:LOVE, REBECCA JANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:JANE
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 1:3491 WIGHTS FORT ROAD
Mailing Address - Street 2:SALT LAKE COMMUNITY COLLEGE HTC 133
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088
Mailing Address - Country:US
Mailing Address - Phone:801-957-2773
Mailing Address - Fax:
Practice Address - Street 1:3491 WIGHTS FORT ROAD
Practice Address - Street 2:SALT LAKE COMMUNITY COLLEGE HTC 133
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088
Practice Address - Country:US
Practice Address - Phone:801-957-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5034715-9922122300000X
CA12416122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist