Walter Andrews Thames Jr., DMD
Individual provider Active NPI General Practice Dentistry · Nettleton, MS
NPI 1104914431 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1104914431
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 2204-85 (MS)
- Practice address
- 228 Main Street
Nettleton, MS 38858 - Phone
- (662) 963-7338
- Fax
- (662) 963-7339
- NPI assigned
- Oct 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141211001768 | MS | Order and Referring Only - Oral Surgery |
1951623420 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2204-85 | MS | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nettleton Dental LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2204-85 | MS | Yes |
Addresses
Primary practice location
228 Main Street
Nettleton, MS 38858
Mailing address
PO Box 388
228 Main Street
Nettleton, MS 38858-0388
Phone (662) 963-7338
Other providers in Nettleton, MS
- Cynthia J Rushing
- Saving Grace Respite Center
- Select Choice at Home Family Care
- Christopher Jarvene Shackelford
- Thomas Andrew Spradling
- The Baulch Center, LLC
- Jerry Vaughn
- W. a. Thames, DMD
- Memory Brooke Williams
- Audra Wright
All providers in Nettleton, MS · General Practice Dentistry in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.