Provider Demographics
NPI:1023300068
Name:LOVE YOUR SMILE DENTAL HYGIENE
Entity type:Organization
Organization Name:LOVE YOUR SMILE DENTAL HYGIENE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ REGISTERED DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:505-688-4259
Mailing Address - Street 1:710 PRIMROSE AVE SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-4857
Mailing Address - Country:US
Mailing Address - Phone:505-688-4259
Mailing Address - Fax:
Practice Address - Street 1:7520 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE D-3
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1521
Practice Address - Country:US
Practice Address - Phone:505-883-7744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH2660261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental