Provider Demographics
NPI:1558816181
Name:PFD LLC
Entity Type:Organization
Organization Name:PFD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:PAPANIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-234-6321
Mailing Address - Street 1:412 SECURITY SQ
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-1952
Mailing Address - Country:US
Mailing Address - Phone:228-896-6321
Mailing Address - Fax:228-896-6322
Practice Address - Street 1:412 SECURITY SQ
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1952
Practice Address - Country:US
Practice Address - Phone:228-896-6321
Practice Address - Fax:228-896-6322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3305-04122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04524749Medicaid