Provider Demographics
NPI:1477920585
Name:MISSISSIPPI AFFORDABLE DENTISTRY
Entity type:Organization
Organization Name:MISSISSIPPI AFFORDABLE DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HAIK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-351-9949
Mailing Address - Street 1:5935 HIGHWAY 18 W
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-9625
Mailing Address - Country:US
Mailing Address - Phone:601-351-9949
Mailing Address - Fax:601-351-9950
Practice Address - Street 1:5935 HIGHWAY 18 W
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-9625
Practice Address - Country:US
Practice Address - Phone:601-351-9949
Practice Address - Fax:601-351-9950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS377214122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty