Provider Demographics
NPI:1720142219
Name:BOUNDS FAMILY DENTAL
Entity Type:Organization
Organization Name:BOUNDS FAMILY DENTAL
Other - Org Name:JAMES A. BOUNDS D.M.D PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:601-649-3511
Mailing Address - Street 1:1010 N 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-2656
Mailing Address - Country:US
Mailing Address - Phone:601-649-3511
Mailing Address - Fax:
Practice Address - Street 1:1010 N 15TH AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-2656
Practice Address - Country:US
Practice Address - Phone:601-649-3511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS200483261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660241Medicaid