Hattiesburg Orthodontics PLLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

3110-99 Issued in MS

Legal business name

HATTIESBURG ORTHODONTICS PLLC

Practice address

704 S 28TH Ave
Suite 20
Hattiesburg, MS 39402-2524

Phone

(601) 450-2141

NPI assigned

Apr 23, 2007

Last updated

Aug 22, 2020By 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

Tracy Faler Stanley, D.M.D. M.S.NPI 1487878906

Title

Owner

Phone

(601) 450-2141

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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.

• Tracy Faler Stanley, D.M.D. M.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Hattiesburg, MS
  • NPI 1487878906
  NPD (past) Authorized official
• Juliana Cran Henderson, D.M.D. M.S.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Hattiesburg, MS
  • NPI 1750505251
  NPD (past)

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083832422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 S 28TH AVE",
            "address_2": "SUITE 20",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394022524",
            "telephone_number": "601-450-2141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 S 28TH AVE",
            "address_2": "SUITE 20",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394022524",
            "telephone_number": "601-450-2141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HATTIESBURG ORTHODONTICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STANLEY",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "FALER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-450-2141",
        "authorized_official_credential": "D.M.D. M.S."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MS",
            "license": "3110-99",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Hattiesburg Public School and Community Clinic
• Hattiesburg Road Dental, P.C. (Sunnybrook Dentistry)
• Hattiesburg Surgery Center, LLC
• Hattiesburg Urgent Care, LLC

• Orthodontics and Dentofacial Orthopedics Dentistry in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.