Provider Demographics
NPI:1831200849
Name:DUMAS, JOHN DALE (DMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:DALE
Last Name:DUMAS
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 1:617 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-4024
Mailing Address - Country:US
Mailing Address - Phone:601-684-0550
Mailing Address - Fax:601-684-3678
Practice Address - Street 1:617 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-4024
Practice Address - Country:US
Practice Address - Phone:601-684-0550
Practice Address - Fax:601-684-3678
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2995-971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660358Medicaid