Chandra M. Minor, D.M.D.
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Hazlehurst, MS
NPI 1548690688 · NPPES record last updated Oct 8, 2018
Key facts
- NPI
- 1548690688
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- OR-484-14 (MS)
- Practice address
- 1047 W Gallman Rd
Hazlehurst, MS 39083-9452 - Phone
- (601) 955-7844
- NPI assigned
- Nov 26, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
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 |
|---|---|---|---|
| 3651-12 | MS | MD | Dentist |
| OR-484-14 | MS | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Smile Design Orthodontics, LLC | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3651-12 | MS | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | OR-484-14 | MS | Yes |
Addresses
Primary practice location
1047 W Gallman Rd
Hazlehurst, MS 39083-9452
Mailing address
201 Riverwind Dr
Pearl, MS 39208-5653
Phone (601) 965-9561
Other providers in Hazlehurst, MS
- Fred J McDonnell
- Preston McDonnell
- Elizabeth McKinley
- Medicomp, Inc
- Jason Dean Miles
- Mississippi Eye Care of Hazlehurst
- Mississippi State Department of Health
- Ms Medical Supplies, Inc.
- Cameron Newell
- Alysia R Newman
All providers in Hazlehurst, MS · Orthodontics and Dentofacial Orthopedics Dentistry in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2018. 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.