NPIMap

Organization Active NPI

Advance Dental Clinic

  • Dentist
  • Jackson, MS
National Provider Identifier
1073708913
Registry record updated Sep 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
3314-04 Issued in MS
Legal business name
ADVANCE DENTAL CLINIC
Practice address
1555 E County Line Rd
Jackson, MS 39211-1801
Phone
(601) 206-1112
Fax
(601) 206-1114
NPI assigned
Sep 13, 2007
Last updated
Sep 13, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2007

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

Authorized official

Name
Dr. Denessa V. Toombs, D.M.D.
Title
Owner/Manager
Phone
(601) 206-1112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 3314-04 MS Primary

Addresses

Primary practice location

1555 E County Line Rd
Jackson, MS 39211-1801

Mailing address

1555 E County Line Rd
Jackson, MS 39211-1801
Phone (601) 206-1112

Other identifiers 1

IdentifierTypeStateIssuer
02674220MedicaidMS

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189641600000",
    "number": "1073708913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 E COUNTY LINE RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392111801",
            "telephone_number": "601-206-1112",
            "fax_number": "601-206-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 E COUNTY LINE RD",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392111801",
            "telephone_number": "601-206-1112",
            "fax_number": "601-206-1114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCE DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-13",
        "last_updated": "2007-09-13",
        "status": "A",
        "authorized_official_last_name": "TOOMBS",
        "authorized_official_first_name": "DENESSA",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "601-206-1112",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "3314-04",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02674220",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2007; 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.