Provider Demographics
NPI:1134569981
Name:CAMILLE SANDIFER, DMD, MSD INC
Entity type:Organization
Organization Name:CAMILLE SANDIFER, DMD, MSD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNDSEY
Authorized Official - Middle Name:CAMILLE
Authorized Official - Last Name:SANDIFER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:601-981-5004
Mailing Address - Street 1:4500 I 55 N
Mailing Address - Street 2:HIGHLAND VILLAGE #247
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-5930
Mailing Address - Country:US
Mailing Address - Phone:601-981-5004
Mailing Address - Fax:601-981-0501
Practice Address - Street 1:4500 I 55 N
Practice Address - Street 2:HIGHLAND VILLAGE #247
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5930
Practice Address - Country:US
Practice Address - Phone:601-981-5004
Practice Address - Fax:601-981-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOR-458-121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty