NPIMap

Organization Active NPI

JCC, LLC

  • Pediatric Dentistry
  • Hernando, MS
National Provider Identifier
1669850004
Registry record updated May 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
PEDO 359 02 Issued in MS
Legal business name
JCC, LLC
Practice address
1150 Monteith Avenue
Suite 102
Hernando, MS 38632
Phone
(662) 298-2095
NPI assigned
May 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2015

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

Authorized official

Name
Dr. Jason Coleman, DMD
Title
Owner
Phone
(662) 298-2095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X PEDO 359 02 MS Primary

Addresses

Primary practice location

1150 Monteith Avenue
Suite 102
Hernando, MS 38632

Mailing address

1150 Monteith Avenue
Suite 102
Hernando, MS 38632
Phone (662) 298-2095

Other names 1

  • Children's Dental Center Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1431907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431907200000",
    "number": "1669850004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 MONTEITH AVENUE",
            "address_2": "SUITE 102",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "38632",
            "telephone_number": "662-298-2095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 MONTEITH AVENUE",
            "address_2": "SUITE 102",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "38632",
            "telephone_number": "662-298-2095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JCC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-18",
        "last_updated": "2015-05-18",
        "status": "A",
        "authorized_official_last_name": "COLEMAN",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-298-2095",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MS",
            "license": "PEDO 359 02",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hernando, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2015; 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.