Provider Demographics
NPI:1508267691
Name:GARNER NICHOLS DENTAL PLLC
Entity Type:Organization
Organization Name:GARNER NICHOLS DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATTY
Authorized Official - Middle Name:B
Authorized Official - Last Name:TOUPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-271-7300
Mailing Address - Street 1:4127 LINCOLN ROAD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402
Mailing Address - Country:US
Mailing Address - Phone:601-271-7300
Mailing Address - Fax:
Practice Address - Street 1:4127 LINCOLN ROAD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402
Practice Address - Country:US
Practice Address - Phone:012-717-3006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04436509Medicaid
MS04436509Medicaid