Provider Demographics
NPI:1467228437
Name:DENTAL PROFESSIONALS OF MISSISSIPPI, P.C.
Entity Type:Organization
Organization Name:DENTAL PROFESSIONALS OF MISSISSIPPI, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:H.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-540-2100
Mailing Address - Street 1:4033 FOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-1384
Mailing Address - Country:US
Mailing Address - Phone:662-913-4778
Mailing Address - Fax:662-913-4776
Practice Address - Street 1:4033 FOUNTAIN LN
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-1384
Practice Address - Country:US
Practice Address - Phone:662-913-4778
Practice Address - Fax:662-913-4776
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL PROFESSIONALS OF MISSISSIPPI, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty