Active NPI
Daryl Roby, DMD
- Dentist
- Durant, MS
National Provider Identifier
1366533283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 283794
- Practice address
- 15423 N Jackson St
Durant, MS 39063-4003 - Phone
- (662) 653-3880
- Fax
- (662) 653-3890
- NPI assigned
- Sep 27, 2006
- Last updated
- Jan 27, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 283794 | MS | Primary |
| 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 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00660253 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DNO14632 | GA | MD | Dentist |
| 283794 | MS | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1390780800000",
"number": "1366533283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15423 N JACKSON ST",
"city": "DURANT",
"state": "MS",
"postal_code": "390634003",
"telephone_number": "662-653-3880",
"fax_number": "662-653-3890"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15423 N JACKSON ST",
"city": "DURANT",
"state": "MS",
"postal_code": "390634003",
"telephone_number": "662-653-3880",
"fax_number": "662-653-3890"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBY",
"first_name": "DARYL",
"name_prefix": "Mr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-27",
"last_updated": "2014-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MS",
"license": "283794",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DNO14632",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00660253",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Durant, MS
- Patients Choice Medical Center of Humphreys County, LLC (Patients Choice Clinic of Durant)
- Peace Wellness Center, LLC
- Peace Wellness Mobile Unit
- Tiffany Denice Redd
- Bonita T Roby, LPN
- Rodgers Medical Clinic
- Phillip Eric Rodgers, FNP-C
- S&M Medical Clinic
- Shannon Pritchard (Holmes County Mobility Equipment)
- Wirt Fletcher Shrock Jr., M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.