NPIMap

Organization Active NPI

Center Avenue Dental Care, LLC

  • General Practice Dentistry
  • Sumrall, MS
National Provider Identifier
1710127311
Registry record updated Feb 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3287 Issued in MS
Legal business name
CENTER AVENUE DENTAL CARE, LLC
Practice address
90 Center Ave
Sumrall, MS 39482-5002
Phone
(601) 758-3535
Fax
(601) 758-9225
NPI assigned
Feb 23, 2009
Last updated
Feb 23, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
BISHOP & BASS, P.A.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 23, 2009

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

Authorized official

Name
Dr. Roger Kyle Bass, D.M.D.NPI 1770669020
Title
President
Phone
(601) 765-4355

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3287 MS Primary

Addresses

Primary practice location

90 Center Ave
Sumrall, MS 39482-5002

Mailing address

90 Center Ave
P.O. Box 217
Sumrall, MS 39482-5002
Phone (601) 758-3535

Other identifiers 2

IdentifierTypeStateIssuer
02880272MedicaidMS
01751273MedicaidMS

National Provider Directory

National Provider Directory
Part of
Collins Family Dental Care

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1235347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235347200000",
    "number": "1710127311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 CENTER AVE",
            "address_2": "P.O. BOX 217",
            "city": "SUMRALL",
            "state": "MS",
            "postal_code": "394825002",
            "telephone_number": "601-758-3535",
            "fax_number": "601-758-9225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 CENTER AVE",
            "city": "SUMRALL",
            "state": "MS",
            "postal_code": "394825002",
            "telephone_number": "601-758-3535",
            "fax_number": "601-758-9225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER AVENUE DENTAL CARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BISHOP & BASS, P.A.",
        "enumeration_date": "2009-02-23",
        "last_updated": "2009-02-23",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "KYLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-765-4355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "3287",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02880272",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01751273",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sumrall, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2009; 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.