Chickasaw Family Dental

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

CHICKASAW FAMILY DENTAL

Practice address

457 N Craft Hwy
Chickasaw, AL 36611-1364

Phone

(251) 456-8406

NPI assigned

Feb 17, 2021

Last updated

Oct 14, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lanthea Mangum

Title

Coo

Phone

(601) 271-8710

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1613520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1634169600000",
    "number": "1316530736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "457 N CRAFT HWY",
            "city": "CHICKASAW",
            "state": "AL",
            "postal_code": "366111364",
            "telephone_number": "251-456-8406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "457 N CRAFT HWY",
            "city": "CHICKASAW",
            "state": "AL",
            "postal_code": "366111364",
            "telephone_number": "251-456-8406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICKASAW FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-17",
        "last_updated": "2021-10-14",
        "certification_date": "2021-10-14",
        "status": "A",
        "authorized_official_last_name": "MANGUM",
        "authorized_official_first_name": "LANTHEA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "601-271-8710"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angels on the Earth LLC
• Azalea City Dental, LLC
• Jessie Black, NP
• Diahann B Broughton, RPH
• Kelsey Marie Cawthon
• Anthony Chiedu Chima Jr., LMT
• City of Chickasaw Board of Education
• Compassionate Healing
• Lequita Tnamaine Curtis, NURSING AIDE
• Natalie Lasha Davis, LMT

• Dental Clinic/Center in Chickasaw, AL
• Providers in Chickasaw, AL by specialty
• Dental Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2021; 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.