Provider Demographics
NPI:1124201074
Name:HEAD, CHRISTY DRYDEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:DRYDEN
Last Name:HEAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7117 U S HWY 98 WEST
Mailing Address - Street 2:SUITE 10
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402
Mailing Address - Country:US
Mailing Address - Phone:601-450-4320
Mailing Address - Fax:601-450-4323
Practice Address - Street 1:7117 US HWY 98 WEST
Practice Address - Street 2:SUITE 10
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:601-450-4320
Practice Address - Fax:601-450-4323
Is Sole Proprietor?:No
Enumeration Date:2007-12-14
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3423-071223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04409228Medicaid