NPIMap

Organization Active NPI

LD-Madison, LLC

  • Dental Clinic/Center
  • Madison, MS
National Provider Identifier
1285415216
Registry record updated Nov 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
LD-MADISON, LLC
Practice address
306 Fountains Dr
Madison, MS 39110-6384
Phone
(601) 605-1410
Fax
(601) 605-1367
NPI assigned
Oct 5, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2023

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

Authorized official

Name
Mrs. Lizz Daigneault, BA, MA
Title
Admin Director
Phone
(256) 783-9468

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

306 Fountains Dr
Madison, MS 39110-6384

Mailing address

306 Fountains Dr
Madison, MS 39110-6384
Phone (601) 605-1410

Other names 1

  • Colony Dental Doing business as

National Provider Directory

National Provider Directory

Locations

306 Fountains Dr
Madison, MS 39110
Phone (601) 605-1410

Practitioners & affiliated clinicians

Practitioners 5

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": "1696464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700006400000",
    "number": "1285415216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 FOUNTAINS DR",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106384",
            "telephone_number": "601-605-1410",
            "fax_number": "601-605-1367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 FOUNTAINS DR",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106384",
            "telephone_number": "601-605-1410",
            "fax_number": "601-605-1367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LD-MADISON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-05",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A",
        "authorized_official_last_name": "DAIGNEAULT",
        "authorized_official_first_name": "LIZZ",
        "authorized_official_title_or_position": "ADMIN DIRECTOR",
        "authorized_official_telephone_number": "256-783-9468",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BA, MA"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colony Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Colony Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2023; 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.