Provider Demographics
NPI:1659592525
Name:DOVE, MAXINE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAXINE
Middle Name:E
Last Name:DOVE
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 1:128 STEVENS AVE
Mailing Address - Street 2:
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:
Practice Address - Street 1:128 STEVENS AVE
Practice Address - Street 2:
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:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY399061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice