Provider Demographics
NPI:1770646598
Name:OXFORD DENTAL SPECIALISTS
Entity Type:Organization
Organization Name:OXFORD DENTAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER - MANAGING
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:H
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:662-513-4188
Mailing Address - Street 1:2408 S LAMAR BLVD.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655
Mailing Address - Country:US
Mailing Address - Phone:662-513-4188
Mailing Address - Fax:662-513-4180
Practice Address - Street 1:2408 S LAMAR BLVD.
Practice Address - Street 2:SUITE 1
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655
Practice Address - Country:US
Practice Address - Phone:662-513-4188
Practice Address - Fax:662-513-4180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3306-04 PEDO-397-061223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09870248Medicaid