Waveland Dental Centerpllc
Organization Active NPI Dentist · Waveland, MS
NPI 1336346113 · NPPES record last updated Mar 25, 2011
Key facts
- NPI
- 1336346113
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- Legal business name
- WAVELAND DENTAL CENTERPLLC
- Practice address
- 110 Auderer Blvd
Waveland, MS 39576-2432 - Phone
- (228) 270-0044
- Fax
- (228) 270-0047
- NPI assigned
- Jun 27, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Dana Hal Jones, D.M.D.
- Title
- Owner Dentist
- Phone
- (228) 270-0044
Corporate family (same tax ID) 1
National Provider Directory
- Tax ID family
- Waveland Dental Center PLLC
Locations
110 Auderer Blvd
Waveland, MS 39576
Phone (228) 270-0044
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | Yes |
Addresses
Primary practice location
110 Auderer Blvd
Waveland, MS 39576-2432
Mailing address
110 Auderer Blvd
Waveland, MS 39576-2432
Phone (228) 270-0044
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09702778 | Medicaid | MS | |
| 428436169 | Other | MS | BLUE CROSS BLUE SHIELD |
Other providers in Waveland, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.