NPIMap

Organization Active NPI

Goodman Road Dental PLLC

  • Dentist
  • Olive Branch, MS
National Provider Identifier
1265090443
Registry record updated Jun 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
GOODMAN ROAD DENTAL PLLC
Practice address
7271 Goodman Rd
Olive Branch, MS 38654-1906
Phone
(662) 895-4737
Fax
(662) 893-3239
NPI assigned
Jun 3, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2019

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

Authorized official

Name
Dr. Max S. Breazeal, DDSNPI 1073523049
Title
Owner
Phone
(901) 861-0031

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

7271 Goodman Rd
Olive Branch, MS 38654-1906

Mailing address

7271 Goodman Rd
Olive Branch, MS 38654-1906
Phone (662) 895-4737

Other names 1

  • Goodman Road Dental PLLC Doing business as

National Provider Directory

National Provider Directory

Locations

7271 Goodman Rd
Olive Branch, MS 38654
Phone (662) 895-4737

Practitioners & affiliated clinicians

Practitioners 4

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": "1559520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559520000000",
    "number": "1265090443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7271 GOODMAN RD",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386541906",
            "telephone_number": "662-895-4737",
            "fax_number": "662-893-3239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7271 GOODMAN RD",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386541906",
            "telephone_number": "662-895-4737",
            "fax_number": "662-893-3239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOODMAN ROAD DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-03",
        "last_updated": "2019-06-03",
        "status": "A",
        "authorized_official_last_name": "BREAZEAL",
        "authorized_official_first_name": "MAX",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-861-0031",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goodman Road Dental PLLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olive Branch, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2019; 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.