Daryl Roby, DMD
Individual provider Active NPI Dentist · Durant, MS
NPI 1366533283 · NPPES record last updated Jan 27, 2014
Key facts
- NPI
- 1366533283
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 283794 (MS)
- Practice address
- 15423 N Jackson St
Durant, MS 39063-4003 - Phone
- (662) 653-3880
- Fax
- (662) 653-3890
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DNO14632 | GA | MD | Dentist |
| 283794 | MS | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 283794 | MS | Yes |
| Dentist | 122300000X | DNO14632 | GA |
Addresses
Primary practice location
15423 N Jackson St
Durant, MS 39063-4003
Mailing address
15423 N Jackson St
Durant, MS 39063-4003
Phone (662) 653-3880
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00660253 | Medicaid | MS |
Other providers in Durant, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2014. 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.