Provider Demographics
NPI:1821396896
Name:LOVE, NICOLE S (RDH)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:S
Last Name:LOVE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE D-3
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1521
Mailing Address - Country:US
Mailing Address - Phone:505-688-4259
Mailing Address - Fax:505-878-9904
Practice Address - Street 1:710 PRIMROSE AVE SW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-4857
Practice Address - Country:US
Practice Address - Phone:505-688-4259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH2660124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist