Provider Demographics
NPI:1780705368
Name:STARNES, DENNIS W (BS DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:W
Last Name:STARNES
Suffix:
Gender:M
Credentials:BS DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 W GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-3227
Mailing Address - Country:US
Mailing Address - Phone:601-684-8635
Mailing Address - Fax:601-684-9320
Practice Address - Street 1:511 W GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-3227
Practice Address - Country:US
Practice Address - Phone:601-684-8635
Practice Address - Fax:601-684-9320
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1554-73122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS64-054-8043OtherINDIV. TAX I.D.
MS00063220Medicaid