Provider Demographics
NPI:1407940141
Name:NASH FAMILY DENTISTRY, INC
Entity Type:Organization
Organization Name:NASH FAMILY DENTISTRY, INC
Other - Org Name:NASH FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-634-1812
Mailing Address - Street 1:1201 MISSION PARK DR
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-3747
Mailing Address - Country:US
Mailing Address - Phone:601-634-1812
Mailing Address - Fax:601-630-9559
Practice Address - Street 1:1201 MISSION PARK DR
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-3747
Practice Address - Country:US
Practice Address - Phone:601-634-1812
Practice Address - Fax:601-630-9559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS23541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty