BACK BAY FAMILY DENTISTRY NPI 1316306988

NPI Information

  • NPI: 1316306988
  • Provider Name: BACK BAY FAMILY DENTISTRY
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Organization
  • Address: 10409 BONEY AVE
    DIBERVILLE, MS
    ZIP 39540
  • Phone: (228) 392-0509

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NPI Details

BACK BAY FAMILY DENTISTRY is a general practice dentist in Diberville, MS. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. BACK BAY FAMILY DENTISTRY NPI is 1316306988. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

10409 BONEY AVE
DIBERVILLE, MS
ZIP 39540-813
Phone: (228) 392-0509
Fax: (228) 392-8709

The provider's authorized official is Jeremy W Parker .
The authorized official title is Owner and has the following contact phone number (228) 392-0509.

The enumeration date for this NPI number is 2/11/2016 and was last updated on 2/11/2016.

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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral Practice3553-10MISSISSIPPIYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
109424204MEDICAIDMISSISSIPPI

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: 3/30/2025

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