Provider Demographics
NPI:1821592734
Name:INTEGRITY DENTAL CLINIC, PLLC
Entity Type:Organization
Organization Name:INTEGRITY DENTAL CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:RUMMELLS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-487-2312
Mailing Address - Street 1:201 E LAYFAIR DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-7604
Mailing Address - Country:US
Mailing Address - Phone:601-487-2312
Mailing Address - Fax:601-487-2555
Practice Address - Street 1:201 E LAYFAIR DR STE 100
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-7604
Practice Address - Country:US
Practice Address - Phone:601-487-2312
Practice Address - Fax:601-487-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental