Provider Demographics
NPI:1508958133
Name:MID SOUTH DENTAL CENTER OF JACKSON
Entity Type:Organization
Organization Name:MID SOUTH DENTAL CENTER OF JACKSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.PRESIDENT/ DENTIST PARTNERSHIP
Authorized Official - Prefix:
Authorized Official - First Name:BARINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:BDS
Authorized Official - Phone:601-373-2404
Mailing Address - Street 1:5685 HWY 18 WEST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209
Mailing Address - Country:US
Mailing Address - Phone:601-373-2404
Mailing Address - Fax:601-373-4443
Practice Address - Street 1:5685 HWY 18 WEST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209
Practice Address - Country:US
Practice Address - Phone:601-373-2404
Practice Address - Fax:601-373-4443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental