Southern Family Dentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

SOUTHERN FAMILY DENTISTRY

Practice address

115 Bridgeton PLZ
Byram, MS 39272-8711

Phone

(601) 373-4500

Fax

(601) 373-4503

NPI assigned

May 3, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Aimee Kelly, DMD

Title

Dentist

Phone

(601) 373-4500

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1689896250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 BRIDGETON PLZ",
            "city": "BYRAM",
            "state": "MS",
            "postal_code": "392728711",
            "telephone_number": "601-373-4500",
            "fax_number": "601-373-4503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 BRIDGETON PLZ",
            "city": "BYRAM",
            "state": "MS",
            "postal_code": "392728711",
            "telephone_number": "601-373-4500",
            "fax_number": "601-373-4503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "AIMEE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "601-373-4500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Byram, MS
• Providers in Byram, 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 Jul 21, 2022; 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.