Provider Demographics
NPI:1568188258
Name:LAMAR DENTAL PLLC
Entity Type:Organization
Organization Name:LAMAR DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WAITS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-543-3745
Mailing Address - Street 1:6414 U S HIGHWAY 98
Mailing Address - Street 2:STE 10
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7838
Mailing Address - Country:US
Mailing Address - Phone:601-543-3745
Mailing Address - Fax:
Practice Address - Street 1:6414 U S HIGHWAY 98
Practice Address - Street 2:STE 10
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7838
Practice Address - Country:US
Practice Address - Phone:601-543-3745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1942721477OtherNPI