Monet Kalisha Ducksworth, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3617-11 Issued in MS

Practice address

68 Old Airport Rd
Hattiesburg, MS 39401-8382

Phone

(601) 583-4800

Fax

(601) 584-7769

NPI assigned

Aug 31, 2011

Last updated

Nov 15, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Monet K Samuel Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1314748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321315200000",
    "number": "1669753927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1729",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394031729",
            "telephone_number": "601-545-3700",
            "fax_number": "601-450-2493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "68 OLD AIRPORT RD",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394018382",
            "telephone_number": "601-583-4800",
            "fax_number": "601-584-7769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUCKSWORTH",
        "first_name": "MONET",
        "middle_name": "KALISHA",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-31",
        "last_updated": "2011-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "3617-11",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015171",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH ID#",
            "identifier": "12284817",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MONET",
            "last_name": "SAMUEL",
            "middle_name": "K",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Drew Middleton, DMD
• Fred H. Drews, III
• Mary C Dryden, LPC, LMFT
• Stacy M Dubois
• Deborah Ducksworth-Williams
• Kenneth E. Duff Jr., M.D.
• Rebecca Duff, MD
• Derrick R. Duffield, M. D.
• Brad Andrew Dufrene, PHD
• Annelle Claire Dugas, FNP

• General Practice Dentistry in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.