Active NPI
Edward Leon Gaudet Sr., DDS
- Dentist
- Natchez, MS
National Provider Identifier
1184732679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 129267
- Practice address
- 407 Franklin Street
Natchez, MS 39121 - Phone
- (601) 442-5476
- Fax
- (601) 442-5477
- NPI assigned
- Aug 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 129267 | MS | Primary |
Addresses
Primary practice location
407 Franklin Street
Natchez, MS 39121
Mailing address
PO Box 1143
407 Franklin Street
Natchez, MS 39121
Phone (601) 442-5476
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00060965 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 129267 | MS | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Charis Family Dentistry LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dental Clinic/Center
- Natchez, MS
- NPI 1346627874
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339632000000",
"number": "1184732679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1143",
"address_2": "407 FRANKLIN STREET",
"city": "NATCHEZ",
"state": "MS",
"postal_code": "39121",
"telephone_number": "601-442-5476",
"fax_number": "601-442-5477"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "407 FRANKLIN STREET",
"city": "NATCHEZ",
"state": "MS",
"postal_code": "39121",
"telephone_number": "601-442-5476",
"fax_number": "601-442-5477"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAUDET",
"first_name": "EDWARD",
"middle_name": "LEON",
"name_prefix": "Dr.",
"name_suffix": "Sr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-26",
"last_updated": "2012-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MS",
"license": "129267",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00060965",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Natchez, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.