Healthcare Provider Details

I. General information

NPI: 1083532444
Provider Name (Legal Business Name): ELIZABETH CAROLE RENFROE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 OXFORD RD
NEW ALBANY MS
38652-3115
US

IV. Provider business mailing address

210 COMBS ST
OXFORD MS
38655-3312
US

V. Phone/Fax

Practice location:
  • Phone: 662-534-8597
  • Fax: 662-538-0220
Mailing address:
  • Phone: 662-832-6688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112827
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: