Madison Pediatric Dental Group, PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

MADISON PEDIATRIC DENTAL GROUP, PLLC

Practice address

7728 Old Canton Rd
Suite a
Madison, MS 39110-6103

Phone

(601) 856-1511

Fax

(601) 856-1011

NPI assigned

Mar 10, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Amy Graham Jones, D.M.D.NPI 1649474875

Title

Owner

Phone

(601) 856-1511

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Amy Graham Jones, D.M.D.

  • Pediatric Dentistry
  • Madison, MS
  • NPI 1649474875
  NPD (past) Authorized official
• Gayle Watters, DMD

  • Pediatric Dentistry
  • Madison, MS
  • NPI 1265571491
  NPD (past)

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

{
    "created_epoch": "1268179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268179200000",
    "number": "1669795241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7728 OLD CANTON RD",
            "address_2": "SUITE A",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106103",
            "telephone_number": "601-856-1511",
            "fax_number": "601-856-1011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7728 OLD CANTON RD",
            "address_2": "SUITE A",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391106103",
            "telephone_number": "601-856-1511",
            "fax_number": "601-856-1011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON PEDIATRIC DENTAL GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-10",
        "last_updated": "2010-03-10",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "GRAHAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-856-1511",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08305709",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Madison Professional Eyecare Associates, Inc
• Madison Radiological Group LLC
• Madison Spine Surgery Center, LLC
• Madison Surgicare Center, PLLC
• Magnolia Pediatric Therapy, LLC

• All providers in Madison, MS
• Pediatric Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2010; 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.