Provider Demographics
NPI:1851441570
Name:URGENT CARE DENTAL CENTER P.A.
Entity Type:Organization
Organization Name:URGENT CARE DENTAL CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:FRIEND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-583-4004
Mailing Address - Street 1:P.O. BOX 15068
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-5068
Mailing Address - Country:US
Mailing Address - Phone:601-583-4004
Mailing Address - Fax:601-583-4005
Practice Address - Street 1:2104 HARDY ST
Practice Address - Street 2:
Practice Address - City:HATTISBURG
Practice Address - State:MS
Practice Address - Zip Code:39401
Practice Address - Country:US
Practice Address - Phone:601-583-4004
Practice Address - Fax:501-583-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2366-871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty