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MAIN STREET DENTAL NPI 1043557085


NPI Information

NPI: 1043557085
Provider Name: MAIN STREET DENTAL

Former Legal Business Name: DRS. JOE BRADDY & SIMMONS

Classification: Dentist - 122300000X
Entity Type: Organization
Address:
8747 NORTHWEST DR
SOUTHAVEN, MS
ZIP 38671
Phone: (662) 393-0781
Get Directions

MAIN STREET DENTAL is a dentist in Southaven, MS. The provider is a dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. MAIN STREET DENTAL NPI is 1043557085. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Drs. Joe Braddy & Simmons.

The provider's business location address is:

8747 NORTHWEST DR
SOUTHAVEN, MS
ZIP 38671-409
Phone: (662) 393-0781
Fax: (662) 342-0750

The provider's authorized official is Jarad Braddy .
The authorized official title is Member and has the following contact phone number (662) 393-0781.

The enumeration date for this NPI number is 1/10/2013 and was last updated on 1/28/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1122300000XDentist3341-05MISSISSIPPIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1082288765MEDICAIDMISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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