Raleigh Dental Clinic

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1219-66 Issued in MS

Legal business name

RALEIGH DENTAL CLINIC

Practice address

207 Sylvarena Ave
Raleigh, MS 39153

Phone

(601) 782-9206

NPI assigned

Oct 5, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Bobby D Maddox, DDS

Title

Dentist/Owner

Phone

(601) 782-9206

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679660492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 595",
            "city": "RALEIGH",
            "state": "MS",
            "postal_code": "391530595",
            "telephone_number": "601-782-9206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 SYLVARENA AVE",
            "city": "RALEIGH",
            "state": "MS",
            "postal_code": "39153",
            "telephone_number": "601-782-9206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RALEIGH DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MADDOX",
        "authorized_official_first_name": "BOBBY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "601-782-9206",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "1219-66",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015677",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Georgia Caroline May Mars, DMD
• McGuffee Drugs Inc (Littles Pharmacy)
• Olha McKay, DMD
• Mississippi State Department of Health
• Jalesa Denise Nickson, ED.S
• Region Ten Commission on Mental Health (Weems Mental Health)
• Carol Darlene Richmond-Stephens, CRNP
• Smith County LTC, LLC
• St Dominic Medical Associates LLC (St Dominic Raleigh Family Practice)
• Phil Thompson, DO

• General Practice Dentistry in Raleigh, MS
• Providers in Raleigh, 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 Aug 22, 2020; 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.