Active NPI
Jamaal Edwin Longino, DMD
- Dentist
- Flowood, MS
National Provider Identifier
1205090040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 3483-08
- Practice address
- 105 Ridge Way
Ste
Flowood, MS 39232-3303 - Phone
- (601) 203-1654
- NPI assigned
- Jul 10, 2008
- Last updated
- Apr 25, 2017
- 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 | 3483-08 | MS | Primary |
Addresses
Primary practice location
105 Ridge Way
Ste
Flowood, MS 39232-3303
Mailing address
105 Ridge Way
Ste
Flowood, MS 39232-3303
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 |
|---|---|---|---|
| 3483-08 | MS | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1493078400000",
"number": "1205090040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 RIDGE WAY",
"address_2": "STE",
"city": "FLOWOOD",
"state": "MS",
"postal_code": "392323303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 RIDGE WAY",
"address_2": "STE",
"city": "FLOWOOD",
"state": "MS",
"postal_code": "392323303",
"telephone_number": "601-203-1654"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONGINO",
"first_name": "JAMAAL",
"middle_name": "EDWIN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-07-10",
"last_updated": "2017-04-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MS",
"license": "3483-08",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flowood, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.