Provider Demographics
NPI:1811075245
Name:PRICE, DONALD E (DDS)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:PRICE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:MS
Mailing Address - Zip Code:39666-0789
Mailing Address - Country:US
Mailing Address - Phone:601-276-7915
Mailing Address - Fax:601-276-7929
Practice Address - Street 1:103 LAUREL STREET
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:MS
Practice Address - Zip Code:39666
Practice Address - Country:US
Practice Address - Phone:601-276-7915
Practice Address - Fax:601-276-7929
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1766-77122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist