Active NPI
Randy S Love, DMD
- Dentist
- Canton, MS
National Provider Identifier
1023228319
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1934 81
- Practice address
- 1668 W Peace St
Canton, MS 39046-5332 - Phone
- (601) 859-5213
- Fax
- (601) 859-8771
- NPI assigned
- May 23, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1934 81 | MS | Primary |
Addresses
Primary practice location
1668 W Peace St
Canton, MS 39046-5332
Mailing address
PO Box 588
Canton, MS 39046-0588
Phone (601) 859-5213
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01689068 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1934 81 | MS | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1023228319",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 588",
"city": "CANTON",
"state": "MS",
"postal_code": "390460588",
"telephone_number": "601-859-5213",
"fax_number": "601-859-8771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1668 W PEACE ST",
"city": "CANTON",
"state": "MS",
"postal_code": "390465332",
"telephone_number": "601-859-5213",
"fax_number": "601-859-8771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOVE",
"first_name": "RANDY",
"middle_name": "S",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-23",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MS",
"license": "1934 81",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01689068",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canton, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.