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MISSISSIPPI OROFACIAL PAIN LLC NPI 1639813454


NPI Information

NPI: 1639813454
Provider Name: MISSISSIPPI OROFACIAL PAIN, LLC

Other Name: MISSISSIPPI OROFACIAL PAIN

Classification: Dentist - 1223X2210X
Entity Type: Organization

Specialization: Orofacial Pain

Address:
108 S MAPLE ST STE C
RIDGELAND, MS
ZIP 39157
Phone: (601) 720-7662
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MISSISSIPPI OROFACIAL PAIN, LLC is an orofacial pain dentist in Ridgeland, MS. The provider is a dentist who assesses, diagnoses, and treats patients with complex chronic orofacial pain and dysfunction disorders, oromotor and jaw behavior disorders, and chronic head/neck pain. The dentist has successfully completed an accredited postdoctoral orofacial pain residency training program for dentists of two or more years duration, in accord with the Commission on Dental Accreditation's Standards for Orofacial Pain Residency Programs, and/or meets the requirements for examination and board certification by the American Board of Orofacial Pain. MISSISSIPPI OROFACIAL PAIN, LLC NPI is 1639813454. The provider is registered as an organization entity type.
The provider Other Name Is Mississippi Orofacial Pain.

The provider's business location address is:

108 S MAPLE ST STE C
RIDGELAND, MS
ZIP 39157-305
Phone: (601) 720-7662

The provider's authorized official is Paul Coleman Riley .
The authorized official title is Authorized Official and has the following contact phone number (769) 567-2555.

The enumeration date for this NPI number is 4/27/2022 and was last updated on 12/28/2023.


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
1261QD0000XClinic/CenterDentalNo
21223X2210XDentistOrofacial PainYes

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
11639813454OTHERMISSISSIPPILOCATION NPI
21285640383OTHERMISSISSIPPIPROVIDER NPI

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: 4/28/2024

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