1306047972 NPI number — DR. LESLIE ANNE CARTY DMD

Table of content: ALYSSA PRICE (NPI 1477205938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306047972 NPI number — DR. LESLIE ANNE CARTY DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARTY
Provider First Name:
LESLIE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
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:
1306047972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 69
Provider Second Line Business Mailing Address:
2076 HWY. 51 NORTH
Provider Business Mailing Address City Name:
WESSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39191-0069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-643-0026
Provider Business Mailing Address Fax Number:
601-643-0530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2076 HIGHWAY 51 NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39191-6859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-643-0026
Provider Business Practice Location Address Fax Number:
601-643-0530
Provider Enumeration Date:
05/30/2007

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: 1223G0001X , with the licence number:  3123-00 , 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)

  • Identifier: 00660375 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 551182 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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