Ellisville Family Dental Center PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2366-87 Issued in MS

Legal business name

ELLISVILLE FAMILY DENTAL CENTER PA

Practice address

401 Highway 11 S
Ellisville, MS 39437-3103

Phone

(601) 477-3771

NPI assigned

Jan 12, 2007

Last updated

Aug 31, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stephen L Surber, DMDNPI 1346399953

Title

Owner

Phone

(601) 477-3771

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Stephen L Surber, DMD

  • General Practice Dentistry
  • Ellisville, MS
  • NPI 1346399953
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472601600000",
    "number": "1033269840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 HIGHWAY 11 S",
            "city": "ELLISVILLE",
            "state": "MS",
            "postal_code": "394373103",
            "telephone_number": "601-477-3771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 HIGHWAY 11 S",
            "city": "ELLISVILLE",
            "state": "MS",
            "postal_code": "394373103",
            "telephone_number": "601-477-3771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLISVILLE FAMILY DENTAL CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2016-08-31",
        "status": "A",
        "authorized_official_last_name": "SURBER",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-477-3771",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "2366-87",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Don's Professional Drugs
• Melissa Kay Downing
• Linda Ducksworth
• Pamela Ducksworth, IDD WAIVER SERVICES
• Ellisville Drug Acquisition Co. (Ellisville Drug)
• Ellisville State School (Epsdt)
• Ellisville State School
• Ellisville State School
• Ellisville State School (Ellisville State School Pharmacy)
• Ellisville State School (Clover Circle ICF/MR)

• General Practice Dentistry in Ellisville, MS
• Providers in Ellisville, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.