Goly Rice Henry Jr., DDS
Individual provider Active NPI Dentist · Marks, MS
NPI 1689727554 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1689727554
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 155973 (MS)
- Practice address
- 304 Cherry Street
Marks, MS 38646-1209 - Phone
- (662) 326-8818
- Fax
- (662) 326-2576
- NPI assigned
- Jan 22, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160510000958 | MS | Order and Referring Only - Dentist |
1658660980 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 155973 | MS | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 155973 | MS | Yes |
Addresses
Primary practice location
304 Cherry Street
Marks, MS 38646-1209
Mailing address
304 Cherry Street
Marks, MS 38646-1209
Phone (662) 326-8818
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00063195 | Medicaid | MS |
Other providers in Marks, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.