Provider Demographics
NPI:1023281300
Name:DOCKINS DENATLL, LLC
Entity type:Organization
Organization Name:DOCKINS DENATLL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JO ANDREA
Authorized Official - Middle Name:T
Authorized Official - Last Name:DOCKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-982-0048
Mailing Address - Street 1:500I E WOODROW WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4538
Mailing Address - Country:US
Mailing Address - Phone:601-982-0048
Mailing Address - Fax:601-982-0388
Practice Address - Street 1:500I E WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4538
Practice Address - Country:US
Practice Address - Phone:601-982-0048
Practice Address - Fax:601-982-0388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2819-94122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty