Provider Demographics
NPI:1598113540
Name:JOSEPH BOONE DMD PC
Entity Type:Organization
Organization Name:JOSEPH BOONE DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-664-9981
Mailing Address - Street 1:128 RIVERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8908
Mailing Address - Country:US
Mailing Address - Phone:601-664-9981
Mailing Address - Fax:
Practice Address - Street 1:128 RIVERVIEW DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8908
Practice Address - Country:US
Practice Address - Phone:601-664-9981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3717-13122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty