Provider Demographics
NPI:1932874260
Name:KINCAID DENTAL CENTER
Entity Type:Organization
Organization Name:KINCAID DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LATARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-720-2507
Mailing Address - Street 1:PO BOX 2672
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39130-2672
Mailing Address - Country:US
Mailing Address - Phone:601-720-2507
Mailing Address - Fax:
Practice Address - Street 1:2655 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9516
Practice Address - Country:US
Practice Address - Phone:601-720-2507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty