NPIMap

Organization Active NPI

Quitman Family Dental, PLLC

  • General Practice Dentistry
  • Quitman, MS
National Provider Identifier
1215205331
Registry record updated Dec 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3396-06 Issued in MS
Legal business name
QUITMAN FAMILY DENTAL, PLLC
Practice address
105 E Donald St
Quitman, MS 39355-2342
Phone
(601) 776-2511
Fax
(601) 776-8993
NPI assigned
Dec 3, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2011

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

Authorized official

Name
Dr. William Brock Martin, DMD, JDNPI 1447452636
Title
Dentist, Partner
Phone
(601) 776-2511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 1841-79 MS
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 3396-06 MS Primary

Addresses

Primary practice location

105 E Donald St
Quitman, MS 39355-2342

Mailing address

PO Box 2926
Meridian, MS 39302-2926
Phone (601) 776-2511

National Provider Directory

National Provider Directory

Locations

105 E Donald St
Quitman, MS 39355
Phone (601) 776-2511

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1322870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322870400000",
    "number": "1215205331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2926",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393022926",
            "telephone_number": "601-776-2511",
            "fax_number": "601-776-8993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 E DONALD ST",
            "city": "QUITMAN",
            "state": "MS",
            "postal_code": "393552342",
            "telephone_number": "601-776-2511",
            "fax_number": "601-776-8993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUITMAN FAMILY DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-03",
        "last_updated": "2011-12-03",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "BROCK",
        "authorized_official_title_or_position": "DENTIST, PARTNER",
        "authorized_official_telephone_number": "601-776-2511",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD, JD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MS",
            "license": "1841-79",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "3396-06",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quitman, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2011; 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.