1356416556 NPI number — DR. NEVA PENTON EKLUND D.M.D.

Table of content: DR. NEVA PENTON EKLUND D.M.D. (NPI 1356416556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356416556 NPI number — DR. NEVA PENTON EKLUND D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EKLUND
Provider First Name:
NEVA
Provider Middle Name:
PENTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356416556
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 LAMPLIGHTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARL
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39208-3935
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-932-0313
Provider Business Mailing Address Fax Number:
601-984-6103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 NORTH STATE ST.
Provider Second Line Business Practice Location Address:
SCHOOL OF DENTISTRY DEPT OF PED AND PUB HEALTH DENT
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39216-4505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-984-6100
Provider Business Practice Location Address Fax Number:
601-984-6103
Provider Enumeration Date:
11/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  2687-92D , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)