Provider Demographics
NPI:1639577281
Name:LOVE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:LOVE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVECCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-904-2300
Mailing Address - Street 1:2766 ELECTRIC RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3583
Mailing Address - Country:US
Mailing Address - Phone:540-904-2300
Mailing Address - Fax:540-206-3972
Practice Address - Street 1:2766 ELECTRIC RD
Practice Address - Street 2:SUITE A
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3583
Practice Address - Country:US
Practice Address - Phone:540-904-2300
Practice Address - Fax:540-206-3972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-15
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014120411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty