Provider Demographics
NPI:1457520173
Name:CHOICES FOR DENTAL
Entity Type:Organization
Organization Name:CHOICES FOR DENTAL
Other - Org Name:CHOICES FOR DENTAL MOBILE UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-261-6314
Mailing Address - Street 1:2941 TERRY RD STE 22
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-3072
Mailing Address - Country:US
Mailing Address - Phone:601-373-0566
Mailing Address - Fax:
Practice Address - Street 1:2941 TERRY RD STE 22
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-3072
Practice Address - Country:US
Practice Address - Phone:601-373-0566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOICES FOR DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-27
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare