Provider Demographics
NPI:1497112825
Name:MISSISSIPPI PERIODONTICS AND IMPLANTS PLLC
Entity Type:Organization
Organization Name:MISSISSIPPI PERIODONTICS AND IMPLANTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-856-1919
Mailing Address - Street 1:218 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2312
Mailing Address - Country:US
Mailing Address - Phone:601-856-1919
Mailing Address - Fax:601-856-1719
Practice Address - Street 1:218 WEST JACKSON STREET
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157
Practice Address - Country:US
Practice Address - Phone:601-856-1919
Practice Address - Fax:601-856-1719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3551-101223P0300X
MS1880-801223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty