Active NPI
Gail V Benton, D.D.S.
- Pediatric Dentistry
- Jackson, MS
National Provider Identifier
1497747661
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 3521-09
- Practice address
- 4463 N State St
Jackson, MS 39206 - Phone
- (601) 714-2908
- NPI assigned
- Aug 16, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 3521-09 | MS | Primary |
Addresses
Primary practice location
4463 N State St
Jackson, MS 39206
Mailing address
4463 N State St
Jackson, MS 39206
Phone (601) 714-2908
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3521-09 | Other | MS | DENTAL LICENSE |
| 9907750 | Medicaid | MS | |
| 1846066 | Medicaid | LA |
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 |
|---|---|---|---|
| 3521-09 | MS | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476057600000",
"number": "1497747661",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4463 N STATE ST",
"city": "JACKSON",
"state": "MS",
"postal_code": "39206",
"telephone_number": "601-714-2908"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4463 N STATE ST",
"city": "JACKSON",
"state": "MS",
"postal_code": "39206",
"telephone_number": "601-714-2908"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENTON",
"first_name": "GAIL",
"middle_name": "V",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-16",
"last_updated": "2016-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "MS",
"license": "3521-09",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "3521-09",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9907750",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1846066",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.