Jackson Dental Care, PLLC

Primary specialty

DentistTaxonomy code 122300000X

License

235987 Issued in MS

Legal business name

JACKSON DENTAL CARE, PLLC

Practice address

2655 Lakeland Dr
Flowood, MS 39232-9516

Phone

(601) 932-8212

Fax

(601) 939-8169

NPI assigned

Apr 10, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Shirley G Walker

Title

Office Manager

Phone

(601) 932-8212

Specialties & licenses 2

Addresses

Other identifiers 3

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1386867414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2655 LAKELAND DR",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329516",
            "telephone_number": "601-932-8212",
            "fax_number": "601-939-8169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2655 LAKELAND DR",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329516",
            "telephone_number": "601-932-8212",
            "fax_number": "601-939-8169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACKSON DENTAL CARE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "601-932-8212",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MS",
            "license": "192481",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "MS",
            "license": "235987",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID#",
            "identifier": "208026392",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1285640383",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1669488763",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Flowood, MS
• Providers in Flowood, MS by specialty
• Dentist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; 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.