Provider Demographics
NPI:1568677797
Name:PRESLEY, DONALD ANSEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ANSEL
Last Name:PRESLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:BALDWYN
Mailing Address - State:MS
Mailing Address - Zip Code:38824-0247
Mailing Address - Country:US
Mailing Address - Phone:662-365-7814
Mailing Address - Fax:662-365-7643
Practice Address - Street 1:692 GRISHAM STREET
Practice Address - Street 2:
Practice Address - City:BALDWYN
Practice Address - State:MS
Practice Address - Zip Code:38824-0247
Practice Address - Country:US
Practice Address - Phone:662-365-7814
Practice Address - Fax:662-365-7643
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS 2355-871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice