Provider Demographics
NPI:1114210630
Name:HUDSPETH REGIONAL CENTER
Entity Type:Organization
Organization Name:HUDSPETH REGIONAL CENTER
Other - Org Name:HRC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LIPSCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:601-664-6000
Mailing Address - Street 1:PO BOX 127B
Mailing Address - Street 2:
Mailing Address - City:WHITFIELD
Mailing Address - State:MS
Mailing Address - Zip Code:39193-1032
Mailing Address - Country:US
Mailing Address - Phone:601-664-6000
Mailing Address - Fax:601-354-6945
Practice Address - Street 1:HIGHWAY 475 SOUTH
Practice Address - Street 2:
Practice Address - City:WHITFIELD
Practice Address - State:MS
Practice Address - Zip Code:39193
Practice Address - Country:US
Practice Address - Phone:601-664-6000
Practice Address - Fax:601-354-6945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty