Provider Demographics
NPI:1649366717
Name:LOVE, CHRISTINE ANDERSON (DENTIST)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ANDERSON
Last Name:LOVE
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8641 W GRAND RIVER
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-4330
Mailing Address - Country:US
Mailing Address - Phone:810-220-2789
Mailing Address - Fax:810-220-4935
Practice Address - Street 1:8641 W GRAND RIVER
Practice Address - Street 2:SUITE 8
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-4330
Practice Address - Country:US
Practice Address - Phone:810-220-2789
Practice Address - Fax:810-220-4935
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0126551223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics