Provider Demographics
NPI:1124182407
Name:CHOICES FOR DENTAL
Entity Type:Organization
Organization Name:CHOICES FOR DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-261-6314
Mailing Address - Street 1:2941 TERRY RD STE 16
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-3072
Mailing Address - Country:US
Mailing Address - Phone:601-372-0066
Mailing Address - Fax:601-371-6931
Practice Address - Street 1:2941 TERRY RD STE 16
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-3072
Practice Address - Country:US
Practice Address - Phone:601-372-0066
Practice Address - Fax:601-371-6931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental