Provider Demographics
NPI:1770925398
Name:BOONE, JOSEPH (DMD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BOONE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MORRISON DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5239
Mailing Address - Country:US
Mailing Address - Phone:601-925-5163
Mailing Address - Fax:601-925-5184
Practice Address - Street 1:315 MORRISON DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5239
Practice Address - Country:US
Practice Address - Phone:601-925-5163
Practice Address - Fax:601-925-5184
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3717131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice