Community Dental, Inc

Primary specialty

DentistTaxonomy code 122300000X

License

3483-08 Issued in MS

Legal business name

COMMUNITY DENTAL, INC

Practice address

908 Municipal Dr
Brandon, MS 39042-2973

Phone

(601) 825-2150

Fax

(601) 825-2792

NPI assigned

Mar 22, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Jamaal Edwin Longino, D.M.D.

Title

Dentist/President

Phone

(601) 825-2150

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1300752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300752000000",
    "number": "1245539808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "908 MUNICIPAL DR",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390422973",
            "telephone_number": "601-825-2150",
            "fax_number": "601-825-2792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "908 MUNICIPAL DR",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390422973",
            "telephone_number": "601-825-2150",
            "fax_number": "601-825-2792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY DENTAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-22",
        "last_updated": "2011-03-22",
        "status": "A",
        "authorized_official_last_name": "LONGINO",
        "authorized_official_first_name": "JAMAAL",
        "authorized_official_middle_name": "EDWIN",
        "authorized_official_title_or_position": "DENTIST/PRESIDENT",
        "authorized_official_telephone_number": "601-825-2150",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MS",
            "license": "3483-08",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Brandon, MS
• Providers in Brandon, MS by specialty
• Dentist in Mississippi

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