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DENTAL GROUP OF ELLISVILLE PLLC NPI 1972851814


NPI Information

NPI: 1972851814
Provider Name: DENTAL GROUP OF ELLISVILLE, PLLC
Classification: Dentist - 1223G0001X
Entity Type: Organization

Specialization: General Practice

Address:
97 HAL CROCKER ROAD
ELLISVILLE, MS
ZIP 39437
Phone: (601) 477-3779
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DENTAL GROUP OF ELLISVILLE, PLLC is a general practice dentist in Ellisville, 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. DENTAL GROUP OF ELLISVILLE, PLLC NPI is 1972851814. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

97 HAL CROCKER ROAD
ELLISVILLE, MS
ZIP 39437
Phone: (601) 477-3779
Fax: (601) 477-3770

The provider's authorized official is Terry Lake Garner .
The authorized official title is Owner and has the following contact phone number (601) 271-8710.

The enumeration date for this NPI number is 8/27/2012 and was last updated on 3/18/2019.


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 Practice2940-96MISSISSIPPIYes

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
100660377MEDICAIDMISSISSIPPI

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: 5/5/2024

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