Provider Demographics
NPI:1629765821
Name:KEY DENTAL GROUP OF PEARL LLC
Entity Type:Organization
Organization Name:KEY DENTAL GROUP OF PEARL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-856-5227
Mailing Address - Street 1:181 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-4042
Mailing Address - Country:US
Mailing Address - Phone:601-487-7337
Mailing Address - Fax:601-487-7343
Practice Address - Street 1:181 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-4042
Practice Address - Country:US
Practice Address - Phone:601-487-7337
Practice Address - Fax:601-487-7343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty