Provider Demographics
NPI:1497578306
Name:NASH DENTAL GROUP-PEARL
Entity type:Organization
Organization Name:NASH DENTAL GROUP-PEARL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-618-9180
Mailing Address - Street 1:190 RIVERWIND E. DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208
Mailing Address - Country:US
Mailing Address - Phone:601-882-5600
Mailing Address - Fax:
Practice Address - Street 1:190 RIVERWIND E. DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208
Practice Address - Country:US
Practice Address - Phone:601-882-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NASH DENTAL GROUP-PEARL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty