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General NPI Number Information
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NPI Number | 1568842334
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Entity Type | Individual
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Provider Name | ELIJAH RANSOM LOVE D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2015
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Last Update Date | 06/05/2015
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Provider Practice Location Address
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Address Line | 210 HOSPITAL CIR
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City | CHOCTAW
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State | MS
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Zip | 39350-6781
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Country | US
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Telephone | 601-389-4030
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Fax | 601-389-4031
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Provider Business Mailing Address
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Address Line | 642 HAWTHORNE N
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City | BRANDON
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State | MS
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Zip | 39047-8676
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Country | US
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Telephone | 801-864-0718
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 9426322-9922
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License Number State | UT
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