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General NPI Number Information
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NPI Number | 1073202735
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Entity Type | Individual
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Provider Name | LOVELL JASON MORRIS IV DDS
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Gender | Male
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 05/26/2025
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Provider Practice Location Address
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Address Line | 600 N HIGHWAY 190 STE 4
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City | COVINGTON
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State | LA
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Zip | 70433-5083
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Country | US
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Telephone | 985-893-5522
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Fax |
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Provider Business Mailing Address
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Address Line | 4820 SHACKLEFORD RIDGE ROAD
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City | SIGNAL MOUNTAIN
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State | TN
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Zip | 37377
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Country | US
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Telephone | 423-260-3832
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 7651
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License Number State | LA
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