1851441570 NPI number — URGENT CARE DENTAL CENTER P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851441570 NPI number — URGENT CARE DENTAL CENTER P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
URGENT CARE DENTAL CENTER P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1851441570
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 15068
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HATTIESBURG
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39404-5068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-583-4004
Provider Business Mailing Address Fax Number:
601-583-4005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2104 HARDY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HATTISBURG
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-583-4004
Provider Business Practice Location Address Fax Number:
501-583-4005
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FRIEND
Authorized Official First Name:
STACY
Authorized Official Middle Name:
JOYCE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
601-583-4004

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2366-87 , 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)





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