NPIMap

Organization Active NPI

Family Dental Care

  • Dental Clinic/Center
  • Indianola, MS
National Provider Identifier
1679063176
Registry record updated Jun 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
273893 Issued in MS
Legal business name
FAMILY DENTAL CARE
Practice address
501 Park Ave
Indianola, MS 38751
Phone
(662) 887-1272
NPI assigned
May 10, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2018

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

Authorized official

Name
Jodi Page
Title
Insurance Billing
Phone
(662) 887-1272

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 273893 MS Primary
Dental Clinic/Center 261QD0000X 392117 MS

Addresses

Primary practice location

501 Park Ave
Indianola, MS 38751

Mailing address

PO Box 972
Indianola, MS 38751-0972
Phone (662) 887-1272

Other identifiers 4

IdentifierTypeStateIssuer
1477073278OtherNPI
00660041MedicaidMS
07535056MedicaidMS
1417048182OtherNPI

National Provider Directory

National Provider Directory

Locations

501 Park Ave
Indianola, MS 38751
Phone (662) 887-1272

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1679063176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 972",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "387510972",
            "telephone_number": "662-887-1272",
            "fax_number": "662-887-6453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 PARK AVE",
            "city": "INDIANOLA",
            "state": "MS",
            "postal_code": "38751",
            "telephone_number": "662-887-1272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-10",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "PAGE",
        "authorized_official_first_name": "JODI",
        "authorized_official_title_or_position": "INSURANCE BILLING",
        "authorized_official_telephone_number": "662-887-1272"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MS",
            "license": "273893",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MS",
            "license": "392117",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1477073278",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00660041",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07535056",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1417048182",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianola, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; 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.