Provider Demographics
NPI:1477008431
Name:PINE BELT SLEEP PLLC
Entity Type:Organization
Organization Name:PINE BELT SLEEP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STRONG
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-264-5756
Mailing Address - Street 1:6654 U S HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7936
Mailing Address - Country:US
Mailing Address - Phone:601-264-5756
Mailing Address - Fax:
Practice Address - Street 1:6654 U S HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7936
Practice Address - Country:US
Practice Address - Phone:601-264-5756
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS335305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty