Provider Demographics
NPI:1295575926
Name:CORINTH DENTAL
Entity type:Organization
Organization Name:CORINTH DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUTCHESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-287-9500
Mailing Address - Street 1:407 CRUISE ST
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-4742
Mailing Address - Country:US
Mailing Address - Phone:662-287-9500
Mailing Address - Fax:662-287-9596
Practice Address - Street 1:407 CRUISE ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-4742
Practice Address - Country:US
Practice Address - Phone:662-287-9500
Practice Address - Fax:662-287-9596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04958005Medicaid
MS00660170Medicaid