NPIMap

Organization Active NPI

Main Street Family Dentistry PA

  • General Practice Dentistry
  • Tupelo, MS
National Provider Identifier
1376623074
Registry record updated Jun 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
267792 Issued in MS
Legal business name
MAIN STREET FAMILY DENTISTRY PA
Practice address
627 West Main St
Tupelo, MS 38804
Phone
(662) 840-0066
Fax
(662) 840-7966
NPI assigned
Oct 17, 2006
Last updated
Jun 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2015

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

Authorized official

Name
Dr. Brett M Hildenbrand, DMDNPI 1811105729
Title
President
Phone
(662) 840-0066

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 267792 MS Primary
General Practice Dentistry 1223G0001X 324002 MS

Addresses

Primary practice location

627 West Main St
Tupelo, MS 38804

Mailing address

627 West Main St
Tupelo, MS 38804
Phone (662) 840-0066

Other identifiers 3

IdentifierTypeStateIssuer
00660449MedicaidMS
08823205MedicaidMS
07158222MedicaidMS

National Provider Directory

National Provider Directory

Locations

627 W Main St
Tupelo, MS 38804
Phone (662) 804-0066

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433203200000",
    "number": "1376623074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "627 WEST MAIN ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "38804",
            "telephone_number": "662-840-0066",
            "fax_number": "662-840-7966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "627 WEST MAIN ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "38804",
            "telephone_number": "662-840-0066",
            "fax_number": "662-840-7966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET FAMILY DENTISTRY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2015-06-02",
        "status": "A",
        "authorized_official_last_name": "HILDENBRAND",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-840-0066",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "267792",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "324002",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00660449",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08823205",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07158222",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2015; 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.