Provider Demographics
NPI:1376262360
Name:MISSISSIPPI DENTAL CENTER OF PELAHATCHIE
Entity Type:Organization
Organization Name:MISSISSIPPI DENTAL CENTER OF PELAHATCHIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWENER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDLER
Authorized Official - Middle Name:
Authorized Official - Last Name:PLEASANT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-854-7478
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:PELAHATCHIE
Mailing Address - State:MS
Mailing Address - Zip Code:39145-0261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 SECOND ST
Practice Address - Street 2:
Practice Address - City:PELAHATCHIE
Practice Address - State:MS
Practice Address - Zip Code:39145-2786
Practice Address - Country:US
Practice Address - Phone:601-854-7478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental