Active NPI
Kenneth David Nash, DDS
- General Practice Dentistry
- Vicksburg, MS
National Provider Identifier
1609030642
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2354
- Practice address
- 1201 Mission Park Dr
Vicksburg, MS 39180-3747 - Phone
- (601) 634-1812
- Fax
- (601) 630-9559
- NPI assigned
- Jul 17, 2008
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2354 | MS | Primary |
Addresses
Primary practice location
1201 Mission Park Dr
Vicksburg, MS 39180-3747
Mailing address
1201 Mission Park Dr
Vicksburg, MS 39180-3747
Phone (601) 634-1812
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 |
|---|---|---|---|
| 2354 | MS | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nash Family Dentistry, Inc | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Vicksburg, MS
- NPI 1407940141
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216252800000",
"number": "1609030642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 MISSION PARK DR",
"city": "VICKSBURG",
"state": "MS",
"postal_code": "391803747",
"telephone_number": "601-634-1812",
"fax_number": "601-630-9559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 MISSION PARK DR",
"city": "VICKSBURG",
"state": "MS",
"postal_code": "391803747",
"telephone_number": "601-634-1812",
"fax_number": "601-630-9559"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NASH",
"first_name": "KENNETH",
"middle_name": "DAVID",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-17",
"last_updated": "2008-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MS",
"license": "2354",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vicksburg, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.