Provider Demographics
NPI:1922056282
Name:LOVING, LEROY JR (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:LEROY
Middle Name:
Last Name:LOVING
Suffix:JR
Gender:M
Credentials:DDS, MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2352 CANDLER RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-6406
Mailing Address - Country:US
Mailing Address - Phone:404-289-2589
Mailing Address - Fax:404-289-2764
Practice Address - Street 1:2352 CANDLER RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-6406
Practice Address - Country:US
Practice Address - Phone:404-289-2589
Practice Address - Fax:404-289-2764
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0087801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery